October 22nd, 2013
No Support for Broad Screening of Chronic Kidney Disease
Although taught in medical school and widely used in clinical practice, broad screening of otherwise healthy people for chronic kidney disease (CKD) is unwarranted, according to new recommendations from the American College of Physicians published in the Annals of Internal Medicine. People with early kidney disease, who are classified as having stages 1 to 3 CKD, usually do not have symptoms and are generally diagnosed with laboratory tests or imaging.
The authors of “Screening, Monitoring, and Treatment of Stage 1-3 Chronic Kidney Disease” discuss the paucity of evidence in the field and highlight the absence of randomized, controlled trials evaluating the risks and benefits of screening for CKD or evaluating the sensitivity and specificity of screening tests.
“There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease,” said Molly Cooke, ACP President, in a press release. “The potential harms of all the screening tests — false positives, disease labeling, and unnecessary treatment and associated adverse effects — outweigh the benefits.”
Although people with diabetes, hypertension, and cardiovascular disease are at higher risk for CKD, there is no evidence that shows that the benefits of screening outweighs the risks in people with these conditions, according to the document. The recommendations also state that people taking ACE inhibitors or ARBs do not need to be tested for proteinuria.
People who have hypertension and early stage CKD should take either an ACE inhibitor or an ARB. People with CKD who have elevated LDL cholesterol should take a statin. The benefits of these drugs have been demonstrated in clinical trials, though there are no proven differences between ACE inhibitors and ARBs, and the combination of an ACE inhibitor and an ARB increases the risk of adverse events.
The authors also recommended against periodic laboratory monitoring tests of people with early-stage CKD. “Ordering lab tests is not going to have any impact on clinical outcomes of asymptomatic patients with CKD without risk factors but will add unnecessary costs to the health care system due to increased medical visits and unnecessary tests,” said Cooke.