Screening for Chronic Kidney Disease

Abstract

Chronic kidney disease is an important health issue associated with increased morbidity, mortality, and health care costs. Chronic kidney disease is defined as greater than 3 months of decreased kidney function, identified by a reduced estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m 2 or by blood or urine markers of kidney damage regardless of eGFR. 1 Using this definition, about which there remains some controversy, more than 14% of the US population has CKD and 6% have stage 3 CKD or higher. 2,3 Stage 3 CKD confers a greater risk of CKD-related complications and progression to end-stage renal disease (ESRD). 3 Because CKD has a long asymptomatic phase, there are acceptable screening tests, and the health consequences associated with the disease are high, it is a disease that is amenable to screening. Screening could also be beneficial because only 10% of people with CKD know they have the disease, and treatments exist that delay the progression of CKD. 4

Racial and Ethnic Disparities in Diagnosis of Chronic Medical Conditions in the USA

“…Sensitivity analysis using a more stringent definition of high cholesterol (LDL ≥ 130) showed no significant racial/ethnic differences in having undiagnosed high cholesterol. We also The logistic regression also adjusted for gender, age group (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), 50-64, and 65+), education (less than high school, HS or equivalent, and higher than HS), low income, and insurance *P value < 0.05 conducted a sensitivity analysis, adjusting for limited English proficiency (Appendix B online). We found 0.3% Whites, 0.4% Blacks, 43.4% Hispanics, and 19.2% Asians to have limited English proficiency.…”

“…For high cholesterol and kidney diseases, guidelines exist, but there are conflicting recommendations regarding which population should be screened and significant variations in the target screening group. 8,31 Additionally, screening may be influenced by the prevalence and comorbidities associated with these diseases. Hypertension, a comorbid condition for various medical conditions, has resulted in an increased awareness and diagnosis of common diseases.…”

Investigation of a Rise in Obstetric Acute Renal Failure in the United States, 1999–2011

“…10 Although universal screening for chronic kidney disease is generally not recommended, screening is recommended for those with risk factors such as diabetes, hypertension, obesity, or a family history of kidney failure. 11 On the other hand, several reports confirm that pregnancies beyond the first trimester are increasingly common among women with chronic kidney disease, including women with dialysis and renal transplantation. 12,13 In addition, prepregnancy counseling of women with chronic kidney disease has become more optimistic in recent years with improvements in treatment.…”

Early detection of chronic kidney disease in low-income and middle-income countries: development and validation of a point-of-care screening strategy for India

“…Expert groups recommend a targeted, rather than a population-wide, screening approach to detect persons with CKD,5 6 as multiple studies suggest that population-based CKD screening is not cost effective 7 8. Targeted screening strategies developed for LMICs must be implemented in settings where primary care health services are often under-resourced and/or are built within the framework of community outreach rather than in-clinic consultations.…”