CKD: ASN Recommends Screening, Rejects ACP Statement

Laurie Barclay, MD

October 23, 2013

The American Society of Nephrology (ASN) strongly recommends regular screening for chronic kidney disease (CKD), regardless of risk factors, according to an ASN statement released October 22. This recommendation contradicts recent guidelines from the American College of Physicians (ACP), which recommended against screening for CKD in asymptomatic adults without risk factors.

According to the ASN, early CKD is mostly asymptomatic, and early diagnosis and treatment may slow progression and preserve renal function and quality of life. In the United States, CKD prevalence currently exceeds 20 million, and it is the eighth leading cause of death

"If detected early in its progression, kidney disease can be slowed and the transition to dialysis delayed," ASN President Bruce A. Molitoris, MD, said in the ASN statement. "This evidence-based fact is why regular screening and early intervention by a nephrologist is so important to stemming the epidemic of kidney disease in the United States and why ASN strongly recommends it."

The ASN statement indicates that CKD screening is simple and inexpensive but has the potential to improve and save countless lives by detecting early disease.

"Stage 1–3 CKD increases the risk for developing acute kidney injury (AKI) from nephrotoxic medications, sepsis, surgery, or contrast dyes for medical imaging. AKI, which occurs in 23% of hospitalized patients, accelerates CKD to end-stage renal disease," Dr. Molitoris said in the release. "This vicious cycle must be stopped."

ACP and ASN Disagree on CKD Screening

As previously reported by Medscape Medical News, the ACP recently issued a clinical practice guideline, recommending "against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease."

The ASN notes that several of the ACP's recommendations reflect current clinical practice. However, the ASN disagrees with the ACP's recommendation against screening for CKD in asymptomatic adults without risk factors.

"Early detection is the key to preventing patients from progressing to relying on dialysis to stay alive," said ASN Executive Director Tod Ibrahim in the ASN news release. "ASN and its nearly 15,000 members — all of whom are experts in kidney disease — are disappointed by ACP's irresponsible recommendation."

In addition, the ACP recommended not testing for proteinuria in adults with or without diabetes who were being treated with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The ASN disagrees, as they stress the importance of testing renal health in adults receiving antihypertensive medications.

High blood pressure and diabetes are the 2 leading risk factors for developing CKD. According to the Centers for Disease Control and Prevention, more than 1 in 5 hypertensive persons older than 20 years has CKD. Furthermore, US prevalence of diabetes exceeds 25 million, and nearly 180,000 persons have renal failure secondary to diabetes.

"While acknowledging the need for further and larger scale clinical research into CKD and how the disease progresses in its early stages, ASN believes current evidence strongly supports the value of early detection of, and screening for, chronic kidney disease," the society's statement concludes.

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