Screening for chronic kidney disease
- Gregorio T Obrador, MD, MPH
Gregorio T Obrador, MD, MPH
- Adjunct Assistant Professor of Medicine
- Tufts University School of Medicine
- Dean and Professor of Medicine
- Universidad Panamericana School of Medicine
Chronic kidney disease (CKD) is a worldwide public health problem. In the United States, the prevalence of end-stage renal disease (ESRD) is increasing . The rising prevalence of treated ESRD can be attributed to the increase in the number of patients who start renal replacement therapy (RRT) each year and to the increased survival of patients with ESRD.
Patients with ESRD consume a disproportionate share of healthcare resources [2,3]. However, despite the magnitude of the resources committed to the treatment of ESRD and the substantial improvements in the quality of dialysis therapy, these patients continue to experience significant mortality and morbidity and a reduced quality of life [2,4,5].
Under-recognition of earlier stages of CKD and of risk factors for CKD may partially explain the rising prevalence of treated ESRD . Increasing evidence, accumulated in the past decades, indicates that earlier stages of CKD can be detected through laboratory testing and that therapeutic interventions implemented early in the course of CKD are effective in slowing or preventing the progression toward ESRD and its associated complications [6,7].
This topic reviews recommendations for screening patients for CKD. Overviews of the epidemiology and management of CKD and its complications are discussed elsewhere. (See "Epidemiology of chronic kidney disease" and "Overview of the management of chronic kidney disease in adults".)
UNDER-RECOGNITION OF CHRONIC KIDNEY DISEASE
Some evidence suggests that CKD is under-recognized. Based upon findings from the National Health and Nutrition Examination Survey (NHANES), for example, awareness of kidney disease in the United States population is low, particularly among certain patient subsets . Awareness of kidney disease was reported in 40.5, 29.3, 22, and 44.5 percent of patients with stage 1, 2, 3, and 4 disease, respectively. Non-Hispanic blacks, men, and those with hypertension were less likely to know that they had some degree of kidney disease.
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- UNDER-RECOGNITION OF CHRONIC KIDNEY DISEASE
- SCREENING FOR CHRONIC KIDNEY DISEASE
- Risk factors for chronic kidney disease
- Selection of patients for screening
- Methods of screening
- Screening the general population
- Kidney Early Evaluation Program
- Laboratory database screening
- Other biomarkers
- SUMMARY AND RECOMMENDATIONS