Review: Better Evidence Needed to Assess Benefits, Harms of Kidney Disease Screening and Monitoring

There is little evidence to shed light on whether screening for kidney disease in asymptomatic adults would help improve clinical outcomes. (Image: JAMA, ©AMA)

Although some may assume that population-wide screening for chronic kidney disease (CKD) and monitoring its progression in individuals diagnosed with the condition might help improve clinical outcomes through earlier intervention, there is insufficient evidence about associated benefits or harms, say authors of a systematic review appearing today in the Annals of Internal Medicine. The review is intended to provide an evidence base to guide the US Preventive Services Task Force and the American College of Physicians Clinical Guidelines Committee in making recommendations on CKD.

Chronic kidney disease is defined as kidney dysfunction or kidney damage that lasts for at least 3 months. The disease is often progressive and can lead to kidney failure. An estimated 11% of US adults have CKD, 95% of whom have early disease and may be unaware that they have the condition.

The review authors looked for randomized controlled trial findings published in English that evaluated CKD screening, monitoring, or treatment and that reported clinical outcomes. They found no randomized controlled trials of CKD screening in asymptomatic adults with or without recognized risk factors such as diabetes, hypertension, or family history that documented CKD incidence, progression, or complications. They also found no randomized controlled trials studying the monitoring for worsening kidney function or organ damage in adults with early-stage CKD.

The review did find some evidence that treatment of CKD with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II–receptor blockers (ARBs) was most effective in preventing kidney failure in patients with high levels of albumin who also have diabetes and hypertension.

The authors of an accompanying editorial said the review’s findings will probably deter organizations from issuing guidelines or recommendations for screening and monitoring for CKD in asymptomatic adults. The editorial authors did say targeted screening of certain populations with a higher risk for CKD may be warranted and should be considered by physicians, based on individual patient risk factors as well as their own clinical experience.

Categories: Diabetes Mellitus, Hypertension, Renal Diseases