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Screening for Chronic Kidney Disease: U.S. Preventive Services Task Force Recommendation Statement FREE

Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*
[+] Article and Author Information

* For a list of USPSTF members, see the Appendix.

This article was published at www.annals.org on 28 August 2012.


From the U.S. Preventive Services Task Force, Rockville, Maryland.

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).


Ann Intern Med. 2012;157(8):567-570. doi:10.7326/0003-4819-157-8-201210160-00533
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Description: New U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for chronic kidney disease (CKD).

Methods: The USPSTF reviewed evidence on screening for CKD, including evidence on screening, accuracy of screening, early treatment, and harms of screening and early treatment.

Population: This recommendation applies to asymptomatic adults without diagnosed CKD. Testing for and monitoring CKD for the purpose of chronic disease management (including testing and monitoring patients with diabetes or hypertension) are not covered by this recommendation.

Recommendation: The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of routine screening for CKD in asymptomatic adults (I statement).


The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of routine screening for chronic kidney disease (CKD) in asymptomatic adults (I statement).

Common tests considered for CKD screening include creatinine-derived estimates of glomerular filtration rate (GFR) and urine testing for albumin. Testing for and monitoring CKD for the purpose of chronic disease management (including testing and monitoring patients with diabetes or hypertension) are not covered by this recommendation.

See the Clinical Considerations section for suggestions for practice regarding the I statement. See the Figure for a summary of the recommendation and suggestions for clinical practice and Appendix Tables 1 and 2 for the USPSTF grades and classification of levels of certainty about net benefit.

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Figure.

Screening for chronic kidney disease: clinical summary of U.S. Preventive Services Task Force Recommendation.

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Table Jump PlaceholderAppendix Table 1. 

What the USPSTF Grades Mean and Suggestions for Practice

Table Jump PlaceholderAppendix Table 2. 

USPSTF Levels of Certainty Regarding Net Benefit

Importance

Approximately 11% of U.S. adults have CKD, many of whom are elderly. The condition is usually asymptomatic until its advanced stages. Most cases of CKD are associated with diabetes or hypertension.

Detection

Chronic kidney disease is defined as decreased kidney function or kidney damage that persists for at least 3 months. No studies have assessed the sensitivity and specificity of screening for CKD with tests for estimated GFR, microalbuminuria, or macroalbuminuria.

Benefits of Detection and Early Intervention and Treatment

Evidence that routine screening for CKD improves clinical outcomes for asymptomatic adults is inadequate.

Harms of Detection and Early Intervention and Treatment

Evidence on the harms of screening for CKD is inadequate. However, convincing evidence shows that medications used to treat early CKD may have adverse effects.

USPSTF Assessment

The USPSTF concludes that the evidence on routine screening for CKD in asymptomatic adults is lacking, and that the balance of benefits and harms cannot be determined.

Patient Population Under Consideration

This recommendation applies to asymptomatic adults without diagnosed CKD. Testing for and monitoring CKD for the purpose of chronic disease management (including monitoring patients with diabetes or hypertension) are not covered by this recommendation.

Suggestions for Practice Regarding the I Statement
Potential Preventable Burden and Benefits

Chronic kidney disease is very prevalent; in 2011, 11% of the U.S. general population had the condition. However, most affected persons have risk factors for CKD, particularly older age, diabetes, and hypertension. It is usually asymptomatic until its advanced stages. Although there is no evidence on the benefits and harms of screening in the general population of asymptomatic adults, evidence shows that specific treatments for patients with diabetes reduce risk for advanced CKD. The American Diabetes Association recommends screening for CKD in all patients with diabetes. The USPSTF found very limited evidence about whether knowledge of CKD status in patients with isolated hypertension (those who do not also have diabetes or cardiovascular disease) helps in making treatment decisions. However, several organizations recommend screening patients who are being treated for hypertension, including the National Institutes of Health's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Potential Harms

For adults without diabetes or hypertension, risk for CKD and subsequent adverse outcomes from it are small. How many persons with a positive screening test result who will be confirmed to have CKD is unknown. There are no studies on the benefits of early treatment in persons without diabetes or hypertension. Persons who have positive results on a screening test but do not have CKD may experience the harms associated with interventions and treatments without the potential for benefit.

Current Practice

Serum creatinine testing is widely done for various reasons in clinical practice, including chronic disease management for patients with hypertension and diabetes. Many patients with CKD stages 1 to 3 seem to have at least some testing in usual clinical care, probably for other conditions or in response to guidelines from other organizations.

Risk Assessment

No generally accepted risk assessment tool for CKD or risk for complications of CKD exists. Diabetes and hypertension are well-established risk factors with strong links to CKD. Other risk factors for CKD include older age, cardiovascular disease, obesity, and family history.

Screening Tests

Although evidence to recommend routine screening is insufficient, the tests often suggested for screening that are feasible in primary care include testing the urine for protein (micro- or macroalbuminuria) and testing the blood for serum creatinine to estimate GFR. No studies have evaluated the sensitivity and specificity of 1-time testing with either or both tests for diagnosis of CKD, defined as decreased kidney function or kidney damage persisting for at least 3 months.

Treatment

Treatment of early stages of CKD is generally targeted to comorbid conditions, such as diabetes, hypertension, and cardiovascular disease, to reduce the risk for complications and progression of CKD. Treatments include blood pressure medications (particularly angiotensin-converting enzyme inhibitors and angiotensin II–receptor blockers), lipid-lowering agents, and diet modification.

Research Needs and Gaps

Future research to define the sensitivity and specificity of 1-time testing for CKD would help to clarify the usefulness of these tests and interpretation of their results. More research is needed to explore the reasons for and possible interventions to prevent the disproportionate progression to end-stage kidney disease in the African American population. More research is needed on the potential benefits and harms of screening and early treatment of CKD in persons without diabetes or hypertension. Studies that evaluate the effect of screening for CKD in patients with hypertension but not diabetes would help to define the benefits and harms of screening in this risk group.

Burden of Disease

Approximately 11% of Americans have an early form of CKD (12). Most cases are asymptomatic; are identified in early stages; and are associated with diabetes, hypertension, or both. Medicare data show that 48% of patients with CKD (excluding end-stage renal disease) have diabetes, 91% have hypertension, and 46% have atherosclerotic heart disease (12). Other reported risk factors include older age, obesity, and family history. Chronic kidney disease is more prevalent in women (12.6%) than in men (9.7%) and is similar in white (11.6%) and African American (11.2%) adults (12). African Americans are 3 to 5 times more likely to have end-stage renal disease than white Americans (34). Chronic kidney disease is associated with several adverse health outcomes in several studies, including increased risk for death, cardiovascular disease, fractures, bone loss, infections, cognitive impairment, and frailty.

Scope of Review

This is a new topic for the USPSTF and was nominated for consideration by several organizations. The USPSTF reviewed evidence on screening for CKD, including evidence on screening, accuracy of screening, early treatment, and harms of screening and early treatment.

Accuracy of Screening Tests

Although a 1-time creatinine-derived estimate of GFR highly correlates to a 1-time direct measurement of GFR, the USPSTF could not find any studies on the accuracy of screening (with serum creatinine or urinary albumin) for CKD defined as impaired GFR or albuminuria that persists for at least 3 months (12). A few studies provide some information about reliability and false-positive results. Intra-individual variability of urinary albumin is high; reported coefficients of variance estimates range from 30% to 50% (5). Body position, exercise, and fever can affect urinary albumin excretion (5). Although many groups recommend 1-time urinary albumin testing and calculation of a protein–creatinine ratio, no standard for collection and measurement of urinary albumin or creatinine exists. A study using NHANES (National Health and Nutrition Examination Survey) data reported that 37% of persons with microalbuminuria and a GFR of 60 mL/min per 1.73 m2 or greater did not have micro- or macroalbuminuria on repeated testing 2 months later (6). Another study reported that 59% of participants with diabetes and persistent microalbuminuria (defined by repeated abnormal protein–creatinine ratios over a 2-year period) regressed to normal over a subsequent 6-year period (7).

Effectiveness of Early Detection and Treatment

No studies directly evaluate the effectiveness of screening for CKD. Treatment of early stages of CKD is targeted to associated conditions, primarily using medications to control hypertension, diabetes, and cardiovascular disease. There are few studies on early treatment of CKD stages 1 to 3 in persons without chronic diseases (such as hypertension, diabetes, and cardiovascular disease). Evidence shows that identification and treatment of CKD may affect management decisions or health outcomes in patients with established chronic disease, including diabetes, cardiovascular disease, and hypertension, but there is insufficient evidence that identification and early treatment of CKD in asymptomatic adults without these conditions results in improved health outcomes.

Potential Harms of Screening and Treatment

The USPSTF found no studies on the direct harms of screening for CKD. Potential harms of screening include adverse effects from venopuncture and psychological effects of labeling a person with CKD. The USPSTF found no studies on these potential harms. The most important potential for harm could occur because of false-positive test results. Patients could be falsely identified as having CKD and receive unnecessary treatment and diagnostic interventions, with their resultant harmful effects. The USPSTF found insufficient evidence to quantify the overall harms from false-positive test results. As discussed previously, several studies provide limited information about the potential frequency of false-positive test results.

Convincing evidence shows that some harm occurs from medications used to treat comorbid medical conditions associated with early CKD, such as diabetes, hypertension, and cardiovascular disease. Although studies inconsistently report withdrawals or adverse effects by treatment group, commonly reported adverse effects of medications reviewed include cough with angiotensin-converting enzyme inhibitors; hypotension with antihypertension medications; edema with calcium-channel blockers; and hyperkalemia with angiotensin-converting enzyme inhibitors, angiotensin II–receptor blockers, and aldosterone antagonists (12).

Estimate of Magnitude of Net Benefit

Although undiagnosed CKD in its early stages is common and there are potential beneficial disease management interventions for persons with chronic diseases, the USPSTF found insufficient evidence on screening accuracy, benefits of early treatment in the general population (that is, persons without chronic disease), and harms of screening. Therefore, evidence to assess the balance of benefits and harms of screening for CKD in the general asymptomatic adult population is insufficient.

Response to Public Comment

A draft version of this recommendation statement was posted for public comment on the USPSTF Web site from 30 April through 29 May 2012. Most commenters agreed with the USPSTF statement. Several comments requested clarification that this recommendation does not apply to persons with diabetes or hypertension. This information was provided in several places in the statement.

No guidelines from primary care organizations recommend screening all adults for CKD. The National Kidney Foundation recommends assessing risk for CKD in all patients and doing the following for those at increased risk: measure blood pressure, test serum creatinine levels, test urinary albumin levels, and examine urine for erythrocytes and leukocytes (8). The American Diabetes Association recommends annual screening of all persons with diabetes using urinary albumin and serum creatinine testing (9). The National Institutes of Health's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that all persons diagnosed with hypertension should have urinalysis and serum creatinine testing; urine testing for albumin is optional (10).

Consumer Fact Sheet

Appendix: U.S. Preventive Services Task Force

Members of the U.S. Preventive Services Task Force† at the time this recommendation was finalized are Virginia A. Moyer, MD, MPH, Chair (Baylor College of Medicine, Houston, Texas); Michael L. LeFevre, MD, MSPH, Co-Vice Chair (University of Missouri School of Medicine, Columbia, Missouri); Albert L. Siu, MD, MSPH, Co-Vice Chair (Mount Sinai School of Medicine, New York, and James J. Peters Veterans Affairs Medical Center, Bronx, New York); Linda Ciofu Baumann, PhD, RN (University of Wisconsin, Madison, Wisconsin); Kirsten Bibbins-Domingo, PhD, MD (University of California, San Francisco, San Francisco, California); Susan J. Curry, PhD (University of Iowa College of Public Health, Iowa City, Iowa); Mark Ebell, MD, MS (University of Georgia, Athens, Georgia); Glenn Flores, MD (University of Texas Southwestern, Dallas, Texas); Adelita Gonzales Cantu, RN, PhD (University of Texas Health Science Center, San Antonio, Texas); David C. Grossman, MD, MPH (Group Health Cooperative, Seattle, Washington); Jessica Herzstein, MD, MPH (Air Products, Allentown, Pennsylvania); Joy Melnikow, MD, MPH (University of California, Davis, Sacramento, California); Wanda K. Nicholson, MD, MPH, MBA (University of North Carolina School of Medicine, Chapel Hill, North Carolina); Douglas K. Owens, MD, MS (Veteran Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, California); Carolina Reyes, MD, MPH (Virginia Hospital Center, Arlington, Virginia); and Timothy J. Wilt, MD, MPH (University of Minnesota Department of Medicine and Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota). Ned Calonge, MD, MPH, a former USPSTF member, also contributed to the development of this recommendation.

† For a list of current USPSTF members, go to www.uspreventiveservicestaskforce.org/members.htm.

Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald R, Rossini D, et al. Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review 37. AHRQ Publication 11(12)-EHC075-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2012.
 
Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald R, Rossini D, et al. Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: a systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2012; 156:570-81.
PubMed
 
Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol. 2003; 14:2902-7.
PubMed
CrossRef
 
Xue JL, Eggers PW, Agodoa LY, Foley RN, Collins AJ. Longitudinal study of racial and ethnic differences in developing end-stage renal disease among aged medicare beneficiaries. J Am Soc Nephrol. 2007; 18:1299-306.
PubMed
CrossRef
 
Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, et al, National Kidney Disease Education Program-IFCC Working Group on Standardization of Albumin in Urine. Current issues in measurement and reporting of urinary albumin excretion. Clin Chem. 2009; 55:24-38.
PubMed
 
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003; 41:1-12.
PubMed
CrossRef
 
Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003; 348:2285-93.
PubMed
CrossRef
 
National Kidney Foundation.  KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. 2002. Accessed at www.kidney.org/professionals/KDOQI/guidelines_ckd/p9_approach.htm on 27 June 2012.
 
American Diabetes Association. Executive summary: standards of medical care in diabetes—2012. Diabetes Care. 2012; 35:Suppl 1S4-S10.
PubMed
 
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42:1206-52.
PubMed
CrossRef
 

Figures

Grahic Jump Location
Figure.

Screening for chronic kidney disease: clinical summary of U.S. Preventive Services Task Force Recommendation.

Grahic Jump Location

Tables

Table Jump PlaceholderAppendix Table 1. 

What the USPSTF Grades Mean and Suggestions for Practice

Table Jump PlaceholderAppendix Table 2. 

USPSTF Levels of Certainty Regarding Net Benefit

References

Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald R, Rossini D, et al. Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review 37. AHRQ Publication 11(12)-EHC075-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2012.
 
Fink HA, Ishani A, Taylor BC, Greer NL, MacDonald R, Rossini D, et al. Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: a systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2012; 156:570-81.
PubMed
 
Hsu CY, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol. 2003; 14:2902-7.
PubMed
CrossRef
 
Xue JL, Eggers PW, Agodoa LY, Foley RN, Collins AJ. Longitudinal study of racial and ethnic differences in developing end-stage renal disease among aged medicare beneficiaries. J Am Soc Nephrol. 2007; 18:1299-306.
PubMed
CrossRef
 
Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, et al, National Kidney Disease Education Program-IFCC Working Group on Standardization of Albumin in Urine. Current issues in measurement and reporting of urinary albumin excretion. Clin Chem. 2009; 55:24-38.
PubMed
 
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003; 41:1-12.
PubMed
CrossRef
 
Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003; 348:2285-93.
PubMed
CrossRef
 
National Kidney Foundation.  KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. 2002. Accessed at www.kidney.org/professionals/KDOQI/guidelines_ckd/p9_approach.htm on 27 June 2012.
 
American Diabetes Association. Executive summary: standards of medical care in diabetes—2012. Diabetes Care. 2012; 35:Suppl 1S4-S10.
PubMed
 
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42:1206-52.
PubMed
CrossRef
 

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Screening for chronic kidney disease – recommendations in context
Posted on January 3, 2013
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)
Conflict of Interest: None Declared

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.

References

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

(206) 616-5403

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