Principles of Screening for Chronic Kidney Disease

Jaar, Bernard G.; Khatib, Rasha; Plantinga, Laura C.; Boulware, L. Ebony; Powe, Neil R.

doi:10.2215/cjn.02540607

Cited by 56 publications

(56 citation statements)

References 58 publications

(40 reference statements)

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“…Screening for disease in apparently healthy individuals in the hope that early identification can lead to more successful intervention strategies is a very reasonable intention (18). However, such screening needs to address a very specific purposes, must identify the characteristics of the population to be screened with respect to the likely prevalence of disease, and the tools used for screening must be easily applied, relatively inexpensive, and have appropriate levels of sensitivity and specificity.…”

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

confidence: 99%

“…However, such screening needs to address a very specific purposes, must identify the characteristics of the population to be screened with respect to the likely prevalence of disease, and the tools used for screening must be easily applied, relatively inexpensive, and have appropriate levels of sensitivity and specificity. An intervention based on early detection also must improve the long-term outcome of the disease (18). While it is true, as pointed out by Melamed, Bauer, and Hostetter, that the progression of CKD in the presence of definite disease, particularly in the presence of proteinuria, can be modified by interventions, such as the use of inhibitors of angiotensin II, the evidence that such approaches can alter the progression of stage 3 CKD in the absence of other definitive features of kidney damage has not yet been proven.…”

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

confidence: 99%

“…Finally, the cost-effectiveness of screening needs to be estimated and both the benefits and harms clearly articulated (18). Current evidence suggests that CKD may meet criteria for justifying screening (18).…”

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

confidence: 99%

“…Current evidence suggests that CKD may meet criteria for justifying screening (18). What is less certain is what screening methods should be used and what populations should be screened.…”

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

confidence: 99%

“…What is less certain is what screening methods should be used and what populations should be screened. It is widely agreed that additional studies of the "benefits, risks and costs of screening for CKD, including randomized, controlled trials, are needed in the general (US) population before final recommendations can be made" (18). Universal screening for CKD based on eGFR alone cannot be recommended, but targeted screening based on the existence of hypertension, diabetes, or a family history of CKD and proteinuria may be effective (18,19).…”

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

confidence: 99%

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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%

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

confidence: 99%

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

confidence: 99%

“…Current evidence suggests that CKD may meet criteria for justifying screening (18). What is less certain is what screening methods should be used and what populations should be screened.…”

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

confidence: 99%

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

confidence: 99%

See 3 more Smart Citations

Screening for CKD with eGFR

Glassock

Winearls

2008

Clinical Journal of the American Society of Nephrology

154

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Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association With Progression to End-Stage Renal Disease and Mortality

Peralta¹

2011

JAMA

389

273

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Context A triple-marker approach for chronic kidney disease (CKD) evaluation has not been well studied. Objective To evaluate whether combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) would improve identification of risks associated with CKD compared with creatinine alone. Design, Setting, and Participants Prospective cohort study involving 26 643 US adults enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from January 2003 to June 2010. Participants were categorized into 8 groups defined by estimated glomerular filtration rate (GFR) determined by creatinine and by cystatin C of either <60 or ≥60 mL/min/1.73 m2 and ACR of either <30 or ≥30 mg/g. Main Outcome Measures All-cause mortality and incident end-stage renal disease with median follow-up of 4.6 years. Results Participants had a mean age of 65 years, 40% were black, and 54% were women. Of 26 643 participants, 1940 died and 177 developed end-stage renal disease. Among participants without CKD defined by creatinine, 24% did not have CKD by either ACR or cystatin C. Compared with those with CKD defined by creatinine alone, the hazard ratio for death in multivariable-adjusted models was 3.3 (95% confidence interval [CI], 2.0–5.6) for participants with CKD defined by creatinine and ACR; 3.2 (95% CI, 2.2–4.7) for those with CKD defined by creatinine and cystatin C, and 5.6 (95% CI, 3.9–8.2) for those with CKD defined by all biomarkers. Among participants without CKD defined by creatinine, 3863 (16%) had CKD detected by ACR or cystatin C. Compared with participants who did not have CKD by any measure, the HRs for mortality were 1.7 (95% CI, 1.4–1.9) for participants with CKD defined by ACR alone, 2.2 (95% CI, 1.9–2.7) for participants with CKD defined by cystatin C alone, and 3.0 (95% CI, 2.4–3.7) for participants with CKD defined by both measures. Risk of incident end-stage renal disease was higher among those with CKD defined by all markers (34.1 per 1000 person-years; 95% CI, 28.7–40.5 vs 0.33 per 1000 person-years; 95% CI, 0.05–2.3) for those with CKD defined by creatinine alone. The second highest end-stage renal disease rate was among persons missed by the creatinine measure but detected by both ACR and cystatin C (rate per 1000 person-years, 6.4; 95% CI, 3.6–11.3). Net reclassification improvement for death was 13.3% (P<.001) and for end-stage renal disease was 6.4% (P<.001) after adding estimated GFR cystatin C in fully adjusted models with estimated GFR creatinine and ACR. Conclusion Adding cystatin C to the combination of creatinine and ACR measures improved the predictive accuracy for all-cause mortality and end-stage renal disease.

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

et al. 2021

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IMPORTANCE Population-based screening for chronic kidney disease (CKD) is sometimes recommended based on the assumption that detecting CKD is associated with beneficial changes in treatment. However, the treatment of CKD is often similar to the treatment of hypertension or diabetes, which commonly coexist with CKD.OBJECTIVE To determine the frequency with which population-based screening for CKD is associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia.

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Principles of Screening for Chronic Kidney Disease

Cited by 56 publications

References 58 publications

Screening for CKD with eGFR

Screening for CKD with eGFR

Detection of Chronic Kidney Disease With Creatinine, Cystatin C, and Urine Albumin-to-Creatinine Ratio and Association With Progression to End-Stage Renal Disease and Mortality

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

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