Early detection of kidney disease in community settings: the kidney early evaluation program (KEEP)

Brown, Wendy Weinstock; Peters, Rosalind M.; Ohmit, Suzanne E.; Keane, William F.; Collins, Allan J.; Chen, Shu Chen; King, Karren; Klag, Michael J.; Molony, Donald A.; Flack, John M.

doi:10.1016/s0272-6386(03)00405-0

Cited by 209 publications

(181 citation statements)

References 38 publications

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“…Enrichment of the a priori probability of finding an individual with a progressive form of renal disease will enhance the positive predictive value and minimize the negative predictive value of the screening test. Thus, targeted eGFR-based or proteinuria screening of individuals with a history of diabetes, hypertension, or a family history of renal disease may prove to be of value (18,20,24). However, screening for proteinuria alone may be easier, cheaper, and more reliable in this subset of individuals (25).…”

Section: Egfr Should Not Be Used In Isolation As a Means For Screeninmentioning

confidence: 99%

Screening for CKD with eGFR

Glassock

Winearls

2008

Clinical Journal of the American Society of Nephrology

154

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The early identification of chronic kidney disease (CKD) is a legitimate enterprise if it provides meaningful opportunities for effective and safe interventions that reduce the risk of death, end-stage renal disease, or complications of renal dysfunction. The screening of unselected populations not already known to be at risk of CKD has the potential of harm and has not been shown to be cost-effective. The application of formulas for the estimation of GFR (eGFR) to the guidelines for staging of chronic kidney disease (Kidney Disease Outcomes Quality Initiative, K/DOQI) as universal screening tools is of dubious value and has inherent dangers. This conclusion is based both on the unreliability of current formulas for determining eGFR and flaws in the K/DOQI schema for staging of CKD. The failure to take into account the normal age-and gender-associated decline in GFR and the lack of a requirement for other evidence of kidney disease in CKD stage 3 leads to an erroneous categorization of large numbers of mostly elderly and female subjects as having an intermediate stage of a lethal disease. Criteria for CKD staging should take into account the percentile distribution of eGFR by age and gender. Targeted screening for CKD is likely to be more cost-effective than universal screening. Whether early identification and treatment of subjects with "reduced" levels of GFR within the normal range for their age/gender, but without any other manifestations of kidney disease, will reduce the subsequent risk of cardiovascular events or progression to end-stage-renal disease is currently unproven.

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Section: Egfr Should Not Be Used In Isolation As a Means For Screeninmentioning

confidence: 99%

Screening for CKD with eGFR

Glassock

Winearls

2008

Clinical Journal of the American Society of Nephrology

154

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“…In the past decade, 1.1 trillion dollars have been spent on dialysis worldwide [4]. Therefore, early detection of asymptomatic CKD patients is important because early intervention has a reasonable chance of making a positive impact on outcome [5]. Similarly, it is important to prevent or delay disease progression from mild to severe stages [4].…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

Senevirathna

Abeysekera

Nanayakkara

et al. 2011

Environ Health Prev Med

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Background The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country.Methods This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. Results We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. Conclusions Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.

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“…Screening programs may also promote public awareness and education, encourage physician adherence to clinical practice guidelines (1,2), and serve as medical outreach to underserved populations (3). Such programs have benefits, risks, and costs.…”

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confidence: 99%

“…Screening for CKD occurs in many contexts, including during routine care (9), within high-risk populations (1,2), and in the general population (10,11). Population-based screening must ensure follow-up and successful referral to care of test-positive individuals for appropriate diagnosis, treatment, and counseling.…”

mentioning

confidence: 99%