Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review

Gheewala, Pankti A.; Zaidi, Syed Tabish Razi; Jose, Matthew; Bereznicki, Lre; Peterson, Gregory M.; Castelino, Ronald L.

doi:10.1007/s40620-017-0375-0

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…Worldwide, several clinical practice guidelines recommend screening targeted groups of people with established risk factors as an important strategy for early CKD detection (7). Hence, many community-based targeted CKD screening programs have been conducted globally; however, a systematic review evaluating the effectiveness of these programs reported that most interventions lacked methodologic rigor and long-term feasibility (8).…”

Section: Introductionmentioning

confidence: 99%

Australian Community Pharmacists’ Experience of Implementing a Chronic Kidney Disease Risk Assessment Service

et al. 2018

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IntroductionCommunity pharmacists are well positioned to deliver chronic kidney disease (CKD) screening services. However, little is known about the challenges faced by pharmacists during service implementation. This study aimed to explore community pharmacists’ experiences and perceived barriers of implementing a CKD risk assessment service.MethodsData collection was performed by using semistructured, open-ended interview questions. Pharmacists who had implemented a CKD screening service in Tasmania, Australia, were eligible to participate. A purposeful sampling strategy was used to select pharmacists, with variation in demographics and pharmacy location. A conventional content analysis approach was used to conduct the qualitative study. Transcripts were thematically analyzed by using the NVivo 11 software program. Initially, a list of free nodes was generated and data were coded exhaustively into relevant nodes. These nodes were then regrouped to form highly conceptualized themes.ResultsFive broad themes emerged from the analysis: contextual fit within community pharmacy; perceived scope of pharmacy practice; customer perception toward disease prevention; CKD – an underestimated disease; and remuneration for a beneficial service. Pharmacists found the CKD service efficient, user-friendly, and of substantial benefit to their customers. However, several pharmacists observed that their customers lacked interest in disease prevention, and had limited understanding of CKD. More importantly, pharmacists perceived the scope of pharmacy practice to depend substantially on interprofessional collaboration between pharmacists and general practitioners, and customer acknowledgment of pharmacists’ role in disease prevention.ConclusionCommunity pharmacists perceived the CKD service to be worth incorporating into pharmacy practice. To increase uptake, future CKD services should aim to improve customer awareness about CKD before providing risk assessment. Further research investigating strategies to enhance general practitioner involvement in pharmacist-initiated disease prevention services is also needed.

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Section: Introductionmentioning

confidence: 99%

Australian Community Pharmacists’ Experience of Implementing a Chronic Kidney Disease Risk Assessment Service

et al. 2018

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“…This is especially important in determined situations such as exercise, fever or systemic infections, cystitis or generalized inflammatory processes, among others, in which the permeability of the glomerular membrane may be transitorily increased to later return to its basal state. Confirming the presence of a chronic lesion with a second determination after a certain period of time avoids overdiagnosis due to these variations [36,37,38,39]. Although this study did not register these clinical situations, this may explain why an alteration of the ACR was observed in 5.5% of the sample and reduced to 3.8% when the measurement was repeated a second or third time 3 to 5 months later.…”

Section: Discussionmentioning

confidence: 90%

Prevalence of Early Chronic Kidney Disease and Main Associated Factors in Spanish Population: Populational Study

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Rodríguez

et al. 2019

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The aim of this study was to determine the prevalence of early chronic kidney disease (EKD) (stages 1 and 2) and the factors associated. This was a populational study including individuals from 18–75 years randomly selected from 18 Primary Healthcare centers in the area of Barcelonès Nord and Maresme (Catalunya, Spain). Variables: anamnesis, physical examination, blood pressure, and analysis. EKD was defined with by a glomerular filtration rate (GFR) ≥60 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) ≥17 mg/g in men and ≥25 mg/g in women confirmed with two determinations. 2871 individuals: 43% men, mean age 55 years (19–75), 32.2% obese, 50.5% abdominal obesity, 21.1% hypertensive, and 10.6% diabetic. Prevalence of EKD: With one determination 157 individuals (5.5%), 110 men (9%) and 47 women (2.8%); with two determinations 109 individuals (3.8%), 85 men (7%), and 24 women (1.5%). Factors independently associated with the multivariate logistic regression model: Man (OR 3.35), blood pressure ≥ 135/85 mmHg (OR 2.29), BMI ≥ 30 kg/m2 (OR 2.48), glycemia ≥ 100 mg/dL (OR 1.73), smoker (OR 1.67) and age (OR 1.04). The prevalence varies if the diagnosis is established based on one or two analytical determinations, overestimated if only one determination is made and depends on the value chosen to define urine albumin excretion.

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“…24 The diagnosis of CKD requires at least two abnormal values .3 months apart, and therefore a confirmatory test is always needed, at least in theory. 25 Serum creatinine is usually used to estimate eGFR because of its wide availability and long history of clinical use. Compared with equations based solely on serum creatinine, equations using both serum cystatin and creatinine have a lower risk of false positives and slightly higher diagnostic accuracy for CKD.…”

Section: What Tests Can Be Used For Early Detection Of Ckd?mentioning

confidence: 99%

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

Dickinson

2020

JASN

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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.

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Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review

Cited by 12 publications

References 31 publications

Australian Community Pharmacists’ Experience of Implementing a Chronic Kidney Disease Risk Assessment Service

Australian Community Pharmacists’ Experience of Implementing a Chronic Kidney Disease Risk Assessment Service

Prevalence of Early Chronic Kidney Disease and Main Associated Factors in Spanish Population: Populational Study

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

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