🩺 CKD Risk Assessment Tool Chronic Kidney Disease

1. Diabetes (Type 1 or Type 2)?

Yes No

2. High Blood Pressure (Hypertension)?

Yes No

3. Heart disease, heart failure, or prior stroke?

Yes No

4. Family history of kidney disease (parents/siblings)?

Yes No

5. Use of NSAID painkillers (Ibuprofen, Naproxen, Diclofenac)

Rarely (once a month or less) Weekly (1–3 times per week) Daily or almost daily

6. Long-term use of prescription medications for chronic diseases?

Yes No

7. Noticed any urinary changes recently?

🫧 Foamy / frothy urine
🩸 Pink/dark urine (blood)
🌙 Waking to urinate frequently (nocturia)
💧 Reduced urine output

8. Swelling around eyes, ankles, or legs?

Yes No

9. Persistent fatigue, weakness, or trouble concentrating?

Yes No