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
- Marcello Tonelli, MD, SM, FRCPC
Marcello Tonelli, MD, SM, FRCPC
- Associate Vice President (Health Research), University of Calgary
- Senior Associate Dean (Clinical Research), Cumming School of Medicine
- Professor of Medicine, University of Calgary
Chronic kidney disease (CKD) is a worldwide public health problem. In the United States, the prevalence of end-stage renal disease (ESRD) is increasing [1,2]. Patients with ESRD consume a disproportionate share of healthcare resources [2-4] and experience significant mortality and morbidity and a reduced quality of life [3,5,6].
The identification and management of patients who have early stages of CKD may slow or prevent the progression to ESRD [7,8].
This topic reviews recommendations for population-based CKD screening and case finding. 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".)
RATIONALE FOR SCREENING
The rationale for screening for CKD is that earlier detection of CKD allows for the implementation of therapeutic interventions and avoidance of inappropriate exposure to nephrotoxic agents, both which may slow the progression of CKD to end-stage renal disease (ESRD) [7,8]. The detection of CKD also identifies an important risk factor for cardiovascular disease (CVD). (See "Coronary heart disease and myocardial infarction in young men and women", section on 'Coronary risk factors' and "Prevalence of and risk factors for coronary heart disease in diabetes mellitus".)
Early detection of CKD with reduced glomerular filtration rate (GFR) may also facilitate appropriate dosing of medications and allow timely preparation for renal replacement, which may improve outcome . (See "Overview of the management of chronic kidney disease in adults", section on 'Consequences of late referral'.)
- National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1.
- 2016 USRDS Annual Data Report. https://www.usrds.org/adr.aspx (Accessed on December 01, 2016).
- United States Renal Data System. USRDS 2009 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2009.
- United States Renal Data System. USRDS 2000 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2000.
- McClellan WM, Anson C, Birkeli K, Tuttle E. Functional status and quality of life: predictors of early mortality among patients entering treatment for end stage renal disease. J Clin Epidemiol 1991; 44:83.
- DeOreo PB. Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. Am J Kidney Dis 1997; 30:204.
- Giatras I, Lau J, Levey AS. Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting-Enzyme Inhibition and Progressive Renal Disease Study Group. Ann Intern Med 1997; 127:337.
- Pereira BJ. Optimization of pre-ESRD care: the key to improved dialysis outcomes. Kidney Int 2000; 57:351.
- Remuzzi G, Benigni A, Finkelstein FO, et al. Kidney failure: aims for the next 10 years and barriers to success. Lancet 2013; 382:353.
- Nickolas TL, Frisch GD, Opotowsky AR, et al. Awareness of kidney disease in the US population: findings from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2000. Am J Kidney Dis 2004; 44:185.
- Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 2005; 16:180.
- McClellan WM, Knight DF, Karp H, Brown WW. Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: important differences between practice and published guidelines. Am J Kidney Dis 1997; 29:368.
- Ryan TP, Sloand JA, Winters PC, et al. Chronic kidney disease prevalence and rate of diagnosis. Am J Med 2007; 120:981.
- Plantinga LC, Boulware LE, Coresh J, et al. Patient awareness of chronic kidney disease: trends and predictors. Arch Intern Med 2008; 168:2268.
- Tuot DS, Zhu Y, Velasquez A, et al. Variation in Patients' Awareness of CKD according to How They Are Asked. Clin J Am Soc Nephrol 2016; 11:1566.
- Szczech LA, Stewart RC, Su HL, et al. Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease). PLoS One 2014; 9:e110535.
- García-García G, Gutiérrez-Padilla AJ, Chávez-Iñiguez J, et al. Identifying undetected cases of chronic kidney disease in Mexico. Targeting high-risk populations. Arch Med Res 2013; 44:623.
- van der Velde M, Halbesma N, de Charro FT, et al. Screening for albuminuria identifies individuals at increased renal risk. J Am Soc Nephrol 2009; 20:852.
- Imai E, Yamagata K, Iseki K, et al. Kidney disease screening program in Japan: history, outcome, and perspectives. Clin J Am Soc Nephrol 2007; 2:1360.
- Fried L. Are we ready to screen the general population for microalbuminuria? J Am Soc Nephrol 2009; 20:686.
- de Jong PE, Curhan GC. Screening, monitoring, and treatment of albuminuria: Public health perspectives. J Am Soc Nephrol 2006; 17:2120.
- Gansevoort RT, Bakker SJ, de Jong PE. Early detection of progressive chronic kidney disease: is it feasible? J Am Soc Nephrol 2006; 17:1218.
- Komenda P, Ferguson TW, Macdonald K, et al. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis 2014; 63:789.
- Hoerger TJ, Wittenborn JS, Segel JE, et al. A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening. Am J Kidney Dis 2010; 55:463.
- Hoerger TJ, Wittenborn JS, Zhuo X, et al. Cost-effectiveness of screening for microalbuminuria among African Americans. J Am Soc Nephrol 2012; 23:2035.
- Vargas RB, Norris KC. Kidney disease progression and screening cost-effectiveness among African Americans. J Am Soc Nephrol 2012; 23:1915.
- Moyer VA, U.S. Preventive Services Task Force. Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157:567.
- Qaseem A, Hopkins RH Jr, Sweet DE, et al. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2013; 159:835.
- Molitoris BA. Screening: Screening for kidney disease--a lost opportunity. Nat Rev Nephrol 2014; 10:6.
- Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 2007; 72:247.
- KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3:1.
- Naik RP, Derebail VK, Grams ME, et al. Association of sickle cell trait with chronic kidney disease and albuminuria in African Americans. JAMA 2014; 312:2115.
- Ritte R, Luke J, Nelson C, et al. Clinical outcomes associated with albuminuria in central Australia: a cohort study. BMC Nephrol 2016; 17:113.
- Hoy WE. Kidney disease in Aboriginal Australians: a perspective from the Northern Territory. Clin Kidney J 2014; 7:524.
- Yeates K, Tonelli M. Chronic kidney disease among Aboriginal people living in Canada. Clin Nephrol 2010; 74 Suppl 1:S57.
- Wesseling C, Crowe J, Hogstedt C, et al. Mesoamerican Nephropathy: Report from the First International Research Workshop on MeN. Central American Institute for Studies on Toxic Substances (IRET-UNA), Program on Work, Environment and Health in Central American (SALTRA), San Jose, PR 2013. p. 239.
- Wesseling C, Crowe J, Hogstedt C, et al. Resolving the enigma of the mesoamerican nephropathy: a research workshop summary. Am J Kidney Dis 2014; 63:396.
- Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis 2014; 63:506.
- Martín-Cleary C, Ortiz A. CKD hotspots around the world: where, why and what the lessons are. A CKJ review series. Clin Kidney J 2014; 7:519.
- Ferris M, Hogan SL, Chin H, et al. Obesity, albuminuria, and urinalysis findings in US young adults from the Add Health Wave III study. Clin J Am Soc Nephrol 2007; 2:1207.
- Elsayed EF, Sarnak MJ, Tighiouart H, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis 2008; 52:29.
- Foster MC, Hwang SJ, Larson MG, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis 2008; 52:39.
- Chang Y, Ryu S, Choi Y, et al. Metabolically Healthy Obesity and Development of Chronic Kidney Disease: A Cohort Study. Ann Intern Med 2016; 164:305.
- Ryu S, Chang Y, Woo HY, et al. Changes in body weight predict CKD in healthy men. J Am Soc Nephrol 2008; 19:1798.
- Chang AR, Chen Y, Still C, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int 2016; 90:164.
- Vivante A, Golan E, Tzur D, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Intern Med 2012; 172:1644.
- Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144:21.
- National Kidney Disease Education Program (NKDEP) http://www.nkdep.nih.gov/professionals/chronic_kidney_disease.htm#diagnosis. (Accessed on October 09, 2013).
- Annual Data Report of the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003; 42 (Suppl 4):S1.
- Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003; 42:22.
- National Kidney Foundation Kidney Early Evaluation Program (KEEP), KEEP 2006 data report. Am J Kidney Dis 2007; 49 (Suppl 3):S1.
- National Kidney Foundation. Kidney Early Evaluation Program. Annual Data Report. Am J Kidney Dis 2009; 53 (Suppl 4): S1.
- Narva A. Screening is part of kidney disease education. Clin J Am Soc Nephrol 2007; 2:1352.