Chronic Kidney Disease Screening: Evidence Insufficient

Nancy A. Melville

August 27, 2012

August 27, 2012 — Evidence on the potential benefits and harms of screening asymptomatic adults for chronic kidney disease (CKD) is insufficient to recommend the screening on a routine basis, according to a statement of the US Preventive Services Task Force (USPSTF), published online August 28 in the Annals of Internal Medicine.

Several organizations nominated the CKD screening recommendation to the USPSTF as a topic for consideration, prompting the task force to review evidence on a variety of issues related to testing and early treatment.

The findings in all areas were inconclusive. "Although undiagnosed CKD in its early stages is common and there are potential beneficial disease management interventions for persons with chronic diseases, the USPSTF found insufficient evidence on screening accuracy, benefits of early treatment in the general population (that is, persons without chronic disease), and harms of screening," the task force writes.

Approximately 11% of adults in the United States have CKD, and although the disease is associated with older age, diabetes, and hypertension, it is often asymptomatic until reaching an advanced stage.

Tests that are feasible for use in the primary care setting for CKD include analysis of urine for protein (microalbuminuria or macroalbuminuria) and testing serum creatinine levels in blood to estimate glomerular filtration rate; however, evidence on the benefits of routine screening with the tests is lacking, the USPSTF said.

"No studies have evaluated the sensitivity and specificity of 1-time testing with either or both tests for diagnosis of CKD, defined as decreased kidney function or kidney damage persisting for at least 3 months," they write.

For patients with conditions that place them at a higher risk for CKD, medical organization guidelines typically recommend screening: The American Diabetes Association, for instance, recommends CKD screening for all patients with diabetes.

For adults without diabetes or hypertension, however, the risk for CKD and related adverse outcomes is said to be small, and no primary care organizations have guidelines recommending screening for all adults.

The USPSTF found no studies describing direct harms related to CKD screening in asymptomatic adults, but the group noted that the possibility of false-positive results represents the most important potential harm.

"Patients could be falsely identified as having CKD and receive unnecessary treatment and diagnostic interventions, with their resultant harmful effects," the USPSTF said.

The costs involved in testing were not evaluated in the USPSTF review, and the group underscored that the recommendation is not intended to apply to screening and monitoring of CKD as part of chronic disease management for patients, including those with diabetes or hypertension.

The USPSTF receives operating support from the Agency for Healthcare Research and Quality. One author indicated that his institution received some funding for its involvement in the evidence report. One author indicated that she received a grant from the National Institute of Diabetes and Digestive and Kidney Diseases for research on the early detection of chronic kidney disease.

Ann Intern Med. Published online August 28, 2012.