Screening for chronic kidney disease: which strategy?

INTRODUCTION

Screening for chronic kidney disease (CKD) has been increasingly advocated. However, several criticisms have been levied, and screening programs for CKD are not universally accepted.

METHODS AND RESULTS

We discuss the problems of CKD screening and suggest improvements in the diagnostic and therapeutic strategies. Current problems with CKD screening are related to the need for both more efficient screening strategies and better screening tests. Diabetes mellitus, hypertension and age above 60 years seem to be the most important inclusion criteria for a CKD screening program, but only a small and variable proportion of CKD cases detected progress to end-stage renal disease (ESRD). Recent studies suggest that all stages of CKD should be stratified by the presence or absence of albuminuria. This applies particularly to CKD stage 3 in which a large proportion of subjects do not progress any quicker than those without kidney disease. Reduced kidney function and albuminuria are also strong and independent predictors for cardiovascular events. Screening for CKD using existing laboratory databases combined with automated management and referral recommendations based on the available evidence base seems to be a promising strategy for efficient and more adequate handling of the large number of CKD patients.

CONCLUSION

Screening for CKD in the general population is still not recommended. However, high-risk groups like patients with diabetes mellitus or hypertension and subjects above age 60 should have their glomerular filtration rate estimated and be tested for albuminuria. Better interplay between primary and secondary care is needed for successful implementation of CKD clinical guidelines in general practice.