Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force*
* For a list of USPSTF members, see the Appendix.
This article was published at www.annals.org on 28 August 2012.
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: Disclosure forms from USPSTF members can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1735.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Moyer VA, on behalf of the U.S. Preventive Services Task Force*. Screening for Chronic Kidney Disease: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:567-570. doi: 10.7326/0003-4819-157-8-201210160-00533
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Published: Ann Intern Med. 2012;157(8):567-570.
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Ian H. de Boer, Grant Olan, Uptal Patel, for the American Society of Nephrology Chronic Kidney Disease Advisory Group
University of Washington (IHdB), American Society of Nephrology (GO), Duke Clinical Research Institute (UP)
January 3, 2013
Screening for chronic kidney disease – recommendations in context
Screening for Chronic Kidney Disease
Chronic kidney disease (CKD) is a serious and growing public health threat.(1,2) More than 26 million Americans are estimated to have CKD, and only 1 in 10 are aware they have the disease. When identified early, however, the progression of CKD to end-stage renal disease (ESRD) can be slowed or halted.(3)The American Society of Nephrology (ASN) CKD Advisory Group agrees with the USPSTF (4) that insufficient evidence exists to demonstrate that screening for CKD in asymptomatic adults translates into use of effective interventions that in turn lead to improved outcomes. However, a lack of evidence is not the same as evidence that screening, or subsequent interventions, are not effective. In its second annual report to Congress on high-priority evidence gaps for clinical preventive services, USPSTF identified screening for CKD as its top priority. The ASN strongly supports the USPSTF recommendation for further research to fill this evidence gap. Moreover, it is critical to highlight the scope of the USPSTF determination, which specifically excluded people diagnosed with diabetes mellitus or hypertension. Diabetes and hypertension are the most common risk factors for CKD. The prevalence of CKD is approximately 27.5% among the 30.6% of adults 20 years of age or older with hypertension and approximately 34.5% among the 10.6% of US adults 20 years of age or older with diabetes.(2,5) Clinical trials in these populations demonstrate that antihypertensive interventions reduce the risk of both CKD progression and cardiovascular complications.(3) ASN and other professional organizations therefore recommend continued screening for CKD among patients with hypertension and diabetes.(6-8)The presence of other risk factors may also warrant screening. Screening for CKD has been recommended for patients with cardiovascular disease because CKD is common and a strong independent risk factor for cardiovascular events and death in this population.(6,8,9) Moreover, screening individuals with a family history of CKD may reduce the risk of ESRD and help address racial disparities.(6,8) Racial disparities among individuals of African ancestry are due in part to a higher prevalence of high-risk polymorphisms such as those identified in the Apolipoprotein L1 gene.(10) The USPSTF highlighted important unanswered questions regarding CKD screening for asymptomatic adults. ASN supports the USPSTF recommendation to Congress for further research on CKD screening while urging ongoing CKD screening among high-risk populations.
1. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-47.
2. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA : the journal of the American Medical Association. 2011;305(24):2532-9.
3. Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald R, Rossini D, et al. Chronic Kidney Disease Stages 1-3: Screening, Monitoring, and Treatment. Rockville (MD); 2012.
4. Moyer VA on behalf of the U.S. Preventive Services Task Force. Screening for Chronic Kidney Disese: U.S. Preventive Services Task Force Recommendation Statement. 2012;157:567-570.
5. Crews DC, Plantinga LC, Miller ER, 3rd, Saran R, Hedgeman E, Saydah SH, et al. Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States. Hypertension. 2010;55(5):1102-9.
6. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-154.
7. Standards of medical care in diabetes--2012. Diabetes Care. 2012;35 Suppl 1:S11-63.
8. National Institute for Health and Clinical Excellence. Chronic kidney disease: national clinical guideline for early identification and management of chronic kidney disease in adults in primary and secondary care. 2008. Available: http://www.nice.org.uk/cg73. Accessed December 2012.
9. Brosius FC, 3rd, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation. Circulation. 2006;114(10):1083-7.
10. Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, Uscinski Knob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR: Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science 2010; 329:841–845.
Ian H. de Boer, MD, MS
Associate Professor of Medicine
Adjunct Associate Professor of Epidemiology
Division of Nephrology and Kidney Research Institute
University of Washington
Box 359606, 325 9th Ave, Seattle, WA 98104
Nephrology, Guidelines, Chronic Kidney Disease, Prevention/Screening.
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