Screening for Chronic Kidney Disease
Mohamed A. Osman
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorKwaifa S. Ibrahim
Department of Medicine, Wuse District General Hospital, Nigeria
Search for more papers by this authorNikhil Shah
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorSoroush Shojai
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorIkechi G. Okpechi
Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa
Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorAminu K. Bello
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorMohamed A. Osman
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorKwaifa S. Ibrahim
Department of Medicine, Wuse District General Hospital, Nigeria
Search for more papers by this authorNikhil Shah
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorSoroush Shojai
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorIkechi G. Okpechi
Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa
Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorAminu K. Bello
Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorJonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorSummary
Screening is performed to differentiate healthy people from those in the early stages of disease who are not experiencing symptoms or exhibiting signs of disease who are not experiencing symptoms or exhibiting signs of illness. This chapter discusses the utility of a screening program for chronic kidney disease (CKD) with regard to associated outcomes and costs. CKD treatment plans often are unclear and access to healthcare resources may be limited. CKD diagnosis requires detecting persistent structural or functional abnormalities of the kidney through laboratory measurements. It recommends against screening for CKD in asymptomatic adults without risk factors for CKD. Overall, the effectiveness of CKD screening and treatment could be better measured in a cluster randomized trial that can better capture multiple concurrent effects and their influences on patient outcomes.
References
- Raffle A. ( 2018 ). Further resources to interactive learning module screening contents [Internet] . www.healthknowledge.org.uk/interactive-learning/screening (accessed 22 May 2021).
- Kaze , A.D. , Ilori , T. , Jaar , B.G. , and Echouffo-Tcheugui , J.B. ( 2018 ). Burden of chronic kidney disease on the African continent: a systematic review and meta-analysis . BMC Nephrol. 19 ( 1 ): 125 .
- Liyanage , T. , Ninomiya , T. , Jha , V. et al. ( 2015 ). Worldwide access to treatment for end-stage kidney disease: a systematic review . Lancet 385 ( 9981 ): 1975 – 1982 .
- Berns , J.S. ( 2014 ). Routine screening for CKD should be done in asymptomatic adults… selectively . Clin. J. Am. Soc. Nephrol. 9 ( 11 ): 1988 – 1992 .
- Adejumo , O.A. , Akinbodewa , A.A. , Okaka , E.I. et al. ( 2016 ). Chronic kidney disease in Nigeria: late presentation is still the norm . Niger. Med. J. 57 ( 3 ): 185 – 189 .
- Udayaraj , U.P. , Haynes , R. , and Winearls , C.G. ( 2011 ). Late presentation of patients with end-stage renal disease for renal replacement therapy – is it always avoidable? Nephrol. Dial. Transplant. 26 ( 11 ): 3646 – 3651 .
- Ferguson , T.W. , Tangri , N. , Tan , Z. et al. ( 2017 ). Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective . Kidney Int. 92 ( 1 ): 192 – 200 .
- Komenda , P. , Ferguson , T.W. , Macdonald , K. et al. ( 2014 ). Cost-effectiveness of primary screening for CKD: a systematic review . Am. J. Kidney Dis. 63 ( 5 ): 789 – 797 .
- Perico , N. , Plata , R. , Anabaya , A. et al. ( 2005 ). Strategies for national health care systems in emerging countries: the case of screening and prevention of renal disease progression in Bolivia . Kidney Int. Suppl. 97 : S87 – S94 .
- Makusidi , M.A. , Liman , H.M. , Yakubu , A. et al. ( 2013 ). Prevalence of non-communicable diseases and its awareness among inhabitants of Sokoto metropolis: outcome of a screening program for hypertension, obesity, diabetes mellitus and overt proteinuria . Arab. J. Nephrol. Transplant. 6 ( 3 ): 189 – 191 .
- Garcia-Garcia , G. , Marquez-Magana , I. , Renoirte-Lopez , K. et al. ( 2010 ). Screening for kidney disease on World Kidney Day in Jalisco . Mexico. J. Nephrol. 23 ( 2 ): 224 – 230 .
- Sumaili , E.K. , Nseka , N.M. , Lepira , F.B. et al. ( 2008 ). Screening for proteinuria and chronic kidney disease risk factors in Kinshasa: a world kidney day 2007 study . Nephron Clin. Pract. 110 ( 4 ): c220 – c228 .
- Egbi , O.G. , Okafor , U.H. , Miebodei , K.E. et al. ( 2014 ). Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state . Nigeria. J. Clin. Pract. 17 ( 5 ): 602 – 607 .
- Singh , A.K. , Farag , Y.M. , Mittal , B.V. et al. ( 2013 ). Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) study . BMC Nephrol. 14 : 114 .
- Kliger , A.S. ( 2014 ). Screening for CKD: a pro and con debate . Clin. J. Am. Soc. Nephrol. 9 ( 11 ): 1987 .
- Benghanem Gharbi , M. , Elseviers , M. , Zamd , M. et al. ( 2016 ). Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid “over”- and “under”-diagnosis of CKD . Kidney Int. 89 ( 6 ): 1363 – 1371 .
-
Kondo , M.
,
Yamagata , K.
,
Hoshi , S.-L.
et al. (
2012
).
Cost-effectiveness of chronic kidney disease mass screening test in Japan
.
J. Clin. Exp. Nephrol.
16
(
2
):
279
–
291
.
10.1007/s10157-011-0567-1 Google Scholar
- Hallan , S.I. and Stevens , P. ( 2010 ). Screening for chronic kidney disease: which strategy? J. Nephrol. 23 ( 2 ): 147 – 155 .
- Qaseem , A. , Wilt , T.J. , Cooke , M. , and Denberg , T.D. ( 2014 ). The paucity of evidence supporting screening for stages 1–3 CKD in asymptomatic patients with or without risk factors . Clin. J. Am. Soc. Nephrol. 9 ( 11 ): 1993 – 1995 .
- de Lima , A.O. , Kesrouani , S. , Gomes , R.A. et al. ( 2012 ). Population screening for chronic kidney disease: a survey involving 38,721 Brazilians . Nephrol. Dial. Transplant. 27 ( Suppl 3 ): iii135 – iii138 .
- Collins , A.J. , Vassalotti , J.A. , Wang , C. et al. ( 2009 ). Who should be targeted for CKD screening? Impact of diabetes, hypertension, and cardiovascular disease . Am. J. Kidney Dis. 53 ( 3 Suppl 3 ): S71 – S77 .
- Boulware , L.E. , Jaar , B.G. , Tarver-Carr , M.E. et al. ( 2003 ). Screening for proteinuria in US adults: a cost-effectiveness analysis . JAMA 290 ( 23 ): 3101 – 3114 .
- Qaseem , A. , Hopkins , R.H. Jr. , Sweet , D.E. et al. ( 2013 ). Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians . Ann. Intern. Med. 159 ( 12 ): 835 – 847 .
- Levey , A.S. , de Jong , P.E. , Coresh , J. et al. ( 2011 ). The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report . Kidney Int. 80 ( 1 ): 17 – 28 .
- Li , P.K. , Ng , J.K. , Cheng , Y.L. et al. ( 2017 ). Relatives in silent kidney disease screening (RISKS) study: a Chinese cohort study . Nephrology 22 ( Suppl 4 ): 35 – 42 .
- Pope , D. and Stanistreet , D. ( 2017 ). Quantitative Methods for Health Research: A Practical Interactive Guide to Epidemiology and Statistics . Wiley .
- Bell , N.R. , Grad , R. , Dickinson , J.A. et al. ( 2017 ). Better decision making in preventive health screening: balancing benefits and harms . Can. Fam. Physician 63 ( 7 ): 521 – 524 .
- Jaar , B.G. , Khatib , R. , Plantinga , L. et al. ( 2008 ). Principles of screening for chronic kidney disease . Clin. J. Am. Soc. Nephrol. 3 ( 2 ): 601 – 609 .
- Levin , A. , Stevens , P.E. , Bilous , R.W. and Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group et al. ( 2013 ). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease . Kidney Int. Suppl. 3 ( 1 ): 1 – 150 .
- Delanaye , P. , Glassock , R.J. , and De Broe , M.E. ( 2017 ). Epidemiology of chronic kidney disease: think (at least) twice! Clin. Kidney J. 10 ( 3 ): 370 – 374 .
- Komenda , P. , Lavallee , B. , Ferguson , T.W. et al. ( 2016 ). The prevalence of CKD in rural Canadian indigenous peoples: results from the first nations community based screening to improve kidney health and prevent dialysis (FINISHED) screen, triage, and treat program . Am. J. Kidney Dis. 68 ( 4 ): 582 – 590 .
- Uchida , D. , Kawarazaki , H. , Shibagaki , Y. et al. ( 2015 ). Underestimating chronic kidney disease by urine dipstick without serum creatinine as a screening tool in the general Japanese population . J. Clin. Exp. Nephrol. 19 ( 3 ): 474 – 480 .
- Jones , C.A. , McQuillan , G.M. , Kusek , J.W. et al. ( 1998 ). Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey . Am. J. Kidney Dis. 32 ( 6 ): 992 – 999 .
- Wilson JMG , Jungner G , World Health Organization ( 1968 ). Principles and practice of screening for disease .
- Hill , N.R. , Fatoba , S.T. , Oke , J.L. et al. ( 2016 ). Global prevalence of chronic kidney disease – a systematic review and meta-analysis . PLoS One 11 ( 7 ): e0158765 .
- Mills , K.T. , Xu , Y. , Zhang , W. et al. ( 2015 ). A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010 . Kidney Int. 88 ( 5 ): 950 – 957 .
- Coresh , J. , Selvin , E. , Stevens , L.A. et al. ( 2007 ). Prevalence of chronic kidney disease in the United States . JAMA 298 ( 17 ): 2038 – 2047 .
- Thygesen , L.C. and Ersbøll , A.K. ( 2014 ). When the entire population is the sample: strengths and limitations in register-based epidemiology . Eur. J. Epidemiol. 29 ( 8 ): 551 – 558 .
- Stevens , L.A. , Coresh , J. , Greene , T. , and Levey , A.S. ( 2006 ). Assessing kidney function – measured and estimated glomerular filtration rate . N. Engl. J. Med. 354 ( 23 ): 2473 – 2483 .
- Go , A.S. , Chertow , G.M. , Fan , D. et al. ( 2004 ). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization . N. Engl. J. Med. 351 ( 13 ): 1296 – 1305 .
- Jager , K.J. and Fraser , S.D. ( 2017 ) The ascending rank of chronic kidney disease in the global burden of disease study . Nephrol. Dial. Transplant. 32 ( suppl_2 ): ii121 – ii128 .
- Murray , C.J. and Lopez , A.D. ( 2017 ). Measuring global health: motivation and evolution of the Global Burden of Disease Study . Lancet 390 ( 10100 ): 1460 – 1464 .
- Hay , S.I. , Abajobir , A.A. , Abate , K.H. et al. ( 2017 ). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 . Lancet 390 ( 10100 ): 1260 – 1344 .
- Naghavi , M. , Abajobir , A.A. , Abbafati , C. et al. ( 2017 ). Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016 . Lancet 390 ( 10100 ): 1151 – 1210 .
- Bello , A.K. , Levin , A. , Tonelli , M. et al. ( 2017 ). Assessment of global kidney health care status . JAMA 317 ( 18 ): 1864 – 1881 .
- Bello , A.K. , Levin , A. , Tonelli , M. et al. ( 2017 ). Global Kidney Health Atlas: A report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe. Brussels, Belgium: International Society of . Nephrology .
- Moyer , V.A. ( 2012 ). Screening for chronic kidney disease: US Preventive Services Task Force recommendation statement . Ann. Intern. Med. 157 ( 8 ): 567 – 570 .
- Lambert , M. ( 2014 ). ACP releases guideline on screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease . Am. Fam. Physician 90 ( 2 ): 121 – 122 .
- National Institute of Health and Care Excellence (NICE) UK . Chronic kidney disease in adults: assessment and management clinical guideline [CG182] . ( 2014 ). www.nice.org.uk/guidance/cg182/chapter/Introduction (accessed 28 November 2018).
- The American Society of Nephrology (ASN) ( 2013 ). ASN emphasizes need for early detection of kidney disease, a silent killer [press release] .
- Levey , A.S. , Coresh , J. , Bolton , K. et al. ( 2002 ). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification . Am. J. Kidney Dis. 39 ( 2 suppl. 1 ) S1 – S266 .
- Inker , L.A. , Astor , B.C. , Fox , C.H. et al. ( 2014 ). KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD . Am. J. Kidney Dis. 63 ( 5 ): 713 – 735 .
- Akbari , A. , Clase , C.M. , Acott , P. et al. ( 2015 ). Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management . Am. J. Kidney Dis. 65 ( 2 ): 177 – 205 .
- Johnson , D.W. , Atai , E. , Chan , M. et al. ( 2013 ). KHA-CARI guideline: early chronic kidney disease: detection, prevention and management . Nephrology 18 ( 5 ): 340 – 350 .
- MacGregor , M.S. and Taal , M.W. ( 2011 ). Renal Association Clinical Practice Guideline on detection, monitoring and management of patients with CKD . Nephron Clin. Pract. 118 ( Suppl. 1 ): c71 – c100 .
- Saran , R. , Robinson , B. , Abbott , K.C. et al. ( 2017 ). US renal data system 2016 annual data report: epidemiology of kidney disease in the United States . Am. J. Kidney Dis. 69 ( 3 ): A7 – A8 .
- Jha , V. , Wang , A.Y.-M. , and Wang , H. ( 2012 ). The impact of CKD identification in large countries: the burden of illness . Nephrol. Dial. Transplant. 27 ( suppl_3 ): iii32 – iii38 .
- Wang , H. , Yang , L. , Wang , F. , and Zhang , L. ( 2017 ). Strategies and cost-effectiveness evaluation of persistent albuminuria screening among high-risk population of chronic kidney disease . BMC Nephrol. 18 ( 1 ): 135 .
- Manns , B. , Hemmelgarn , B. , Tonelli , M. et al. ( 2010 ). Population based screening for chronic kidney disease: cost effectiveness study . BMJ 341 : c5869 .
- Brown , W.W. , Collins , A. , Chen , S.-C. et al. ( 2003 ). Identification of persons at high risk for kidney disease via targeted screening: the NKF Kidney Early Evaluation Program . Kidney Int. 63 : S50 – S55 .
- Vassalotti , J.A. , Li , S. , Chen , S.-C. , and Collins , A.J. ( 2009 ). Screening populations at increased risk of CKD: the Kidney Early Evaluation Program (KEEP) and the public health problem . Am. J. Kidney Dis. 53 ( 3 ): S107 – S114 .
- Boersma , C. , Gansevoort , R.T. , Pechlivanoglou , P. et al. ( 2010 ). Screen-and-treat strategies for albuminuria to prevent cardiovascular and renal disease: cost-effectiveness of nationwide and targeted interventions based on analysis of cohort data from the Netherlands . Clin. Ther. 32 ( 6 ): 1103 – 1121 .
- Hoerger , T.J. , Wittenborn , J.S. , Segel , J.E. et al. ( 2010 ). A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening . Am. J. Kidney Dis. 55 ( 3 ): 463 – 473 .
- Howard , K. , White , S. , Salkeld , G. et al. ( 2010 ). Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: a modeled analysis . Value Health 13 ( 2 ): 196 – 208 .
- Kessler , R. , Keusch , G. , Szucs , T.D. et al. ( 2012 ). Health economic modelling of the cost-effectiveness of microalbuminuria screening in Switzerland . Swiss Med. Wkly. 142 : w13508 .
- Palmer , A.J. , Valentine , W.J. , Chen , R. et al. ( 2008 ). A health economic analysis of screening and optimal treatment of nephropathy in patients with type 2 diabetes and hypertension in the USA . Nephrol. Dial. Transplant. 23 ( 4 ): 1216 – 1223 .
- Siegel , J.E. , Krolewski , A.S. , Warram , J.H. , and Weinstein , M.C. ( 1992 ). Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus . J. Am. Soc. Nephrol. 3 ( 4 Suppl ): S111 – S119 .
- Chadban , S. , Howell , M. , Twigg , S. et al. ( 2010 ). Cost-effectiveness and socioeconomic implications of prevention and management of chronic kidney disease in type 2 diabetes . Nephrology 15 ( S1 ): S195 – S203 .
- Black C , Sharma P , Scotland G , McCullough K , McGurn D , Robertson L , et al. ( 2010 ). Early Referral Strategies for Management of People with Markers of Renal Disease: A Systematic Review of the Evidence of Clinical Effectiveness, Cost-Effectiveness and Economic Analysis . Prepress Projects Ltd , Perth ( www.prepress-projects.co.uk ) on behalf of NETSCC (NIHR Evaluation, Trials and Studies Coordinating Centre (Great Britain). (accessed 28 November 2018).
- Hoerger , T.J. , Wittenborn , J.S. , Zhuo , X. et al. ( 2012 ). Cost-effectiveness of screening for microalbuminuria among African Americans . J. Am. Soc. Nephrol. 23 ( 12 ): 2035 – 2041 .
- Group SR ( 2015 ). A randomized trial of intensive versus standard blood-pressure control . N. Engl. J. Med. 373 ( 22 ): 2103 – 2116 .
- Tonelli , M. , Isles , C. , Curhan , G.C. et al. ( 2004 ). Effect of pravastatin on cardiovascular events in people with chronic kidney disease . Circulation 110 ( 12 ): 1557 – 1563 .
- Baigent , C. , Landray , M.J. , Reith , C. et al. ( 2011 ). The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial . Lancet 377 ( 9784 ): 2181 – 2192 .
- Fitchett , D. , Zinman , B. , Wanner , C. et al. ( 2016 ). Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial . Eur. Heart J. 37 ( 19 ): 1526 – 1534 .