Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries

Abstract

CKD is common, costly, and associated with adverse health outcomes. Because inexpensive treatments can slow the rate of kidney function loss, and because CKD is asymptomatic until its later stages, the idea of early detection of CKD to improve outcomes ignites enthusiasm, especially in low- and middle-income countries where renal replacement is often unavailable or unaffordable. Available data and prior experience suggest that the benefits of population-based screening for CKD are uncertain; that there is potential for harms; that screening is not a wise use of resources, even in high-income countries; and that screening has substantial opportunity costs in low- and middle-income countries that offset its hypothesized benefits. In contrast, some of the factors that diminish the value of population-based screening (such as markedly higher prevalence of CKD in people with diabetes, hypertension, and cardiovascular disease, as well as high preexisting use of kidney testing in such patients) substantially increase the appeal of searching for CKD in people with known kidney risk factors (case finding) in high-income countries as well as in low- and middle-income countries. For both screening and case finding, detection of new cases is the easiest component; the real challenge is ensuring appropriate management for a chronic disease, usually for years or even decades. This review compares and contrasts the benefits, harms, and opportunity costs associated with these two approaches to early detection of CKD. We also suggest criteria (discussed separately for high-income countries and for low- and middle-income countries) to use in assessing when countries should consider case finding versus when they should consider foregoing systematic attempts at early detection and focus on management of known cases.

Diagnostic Yield of Population-Based Screening for Chronic Kidney Disease in Low-Income, Middle-Income, and High-Income Countries

“… 33 In addition, multiple measurements of eGFR even when the initial value is more than 60 ml/min/1.73 m 2 may help to trigger early intervention for individuals with rapid loss of kidney function. However, these speculative benefits seem unlikely to be associated with large differences in health outcomes on a population level, 16 and a strategy based on multiple measurements among individuals would be very resource intensive.…”

“…When CKD was assessed in this subroup (case finding), the number of participants who required assessment of CKD status was decreased while the proportion of participants with CKD who required a treatment change was similar or was increased compared with screening the entire population (Table 3). Specifically, the number of individuals requiring assessment of CKD status CKD but no change in treatment New CKD with hypertension b 1 (1-2) 1 (0-1) 6 (5-7) 18 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) 13 (11)(12)(13)(14)(15)(16) New CKD with diabetes c 1 (0-1) 1 (0-1) 8 (7-8) 12 (8-16) 9 (7-11)…”

“…For a small proportion (<10%) of individuals with CKD, early detection is associated with the identification of an underlying condition, such as glomerulonephritis, and additional treatment. 16 , 17 Any incremental benefit associated with screening occurs during the period between the detection of CKD by screening and when it would otherwise be detected. However, this assumes that earlier detection is associated with beneficial changes in treatment.…”

Panax Ginseng C.A.Mey. as Medicine: The Potential Use of Panax Ginseng C.A.Mey. as a Remedy for Kidney Protection from a Pharmacological Perspective

“…Chronic Kidney Disease (CKD) usually has concealed onset and gets progressively worse, followed by an increasing burden of hypertension, atherosclerosis, calcium and phosphorus metabolism disorders, renal anaemia and other complications, which is a cause of substantial healthcare expenditure ( Chen et al, 2019 ; Tonelli and Dickinson, 2020 ). Oxidative stress is known as the main mechanism of CKD, and antioxidants have potential value in the treatment of CKD ( Podkowińska and Formanowicz, 2020 ).…”

Chronic Kidney Disease: Current Scenario of diagnosis and treatment in India

“…Recent studies have identified various biomarkers for early detection of CKD (16)(17)(18). One of the exogenous gold standard marker used to assess GFR is inulin (19,20).…”