Division of General Medicine and Primary Care, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
Clin J Am Soc Nephrol. 2013 Jan;8(1):131-5. doi: 10.2215/CJN.12681211. Epub 2012 Aug 23.
Proponents of routine urine dipstick screening to identify patients at risk for ESRD in the primary care setting have argued that urine dipsticks are inexpensive, low risk, acceptable to patients, and now, more accurate. Proponents believe that urine dipstick screening has the potential to improve outcomes for people with early disease and increase awareness of CKD. Most primary care physicians agree that populations who are at high risk for CKD should be tested and appropriately treated to decrease complications of ESRD. However, proponents of mass screening may not appreciate the challenges, limitations, and potential harms of screening. Urine dipstick testing does not meet all of the criteria for a good screening test. Screening the general population with urine dipsticks will generate many false positives--between 50% and 90% of positive tests--that will require follow-up, increase costs, and cause patient anxiety. Routine screening with urine dipsticks is not cost-effective on the order of $200,000 per quality-adjusted life year. Most importantly, there is little evidence that early identification of microalbuminuria in unselected patients influences outcomes of CKD. Without proof of effectiveness, overdiagnosis, a problem for even well established screening tests, is risked. Finally, no specialty society or preventive services group currently recommends general screening. Instead of screening, primary care physicians and nephrologists should work together to identify patients at high risk for ESRD and optimize management to improve outcomes for patients with CKD.
在初级保健环境中，提倡常规尿试纸筛查以识别有发生 ESRD 风险的患者的人认为，尿试纸价格低廉、风险低、患者易于接受，而且现在更加准确。提倡者认为，尿试纸筛查有可能改善早期疾病患者的预后，并提高人们对 CKD 的认识。大多数初级保健医生都认为，应该对有发生 CKD 高风险的人群进行测试和适当治疗，以减少 ESRD 的并发症。然而，大规模筛查的支持者可能没有意识到筛查的挑战、限制和潜在危害。尿试纸检测不符合好的筛查检测的所有标准。用尿试纸对一般人群进行筛查会产生很多假阳性——阳性检测的 50%至 90%——需要进行随访，增加成本，并导致患者焦虑。用尿试纸进行常规筛查，其成本效益约为每质量调整生命年 20 万美元。最重要的是，几乎没有证据表明在未选择的患者中早期发现微量白蛋白尿会影响 CKD 的预后。如果没有有效性的证据，即使是经过充分证实的筛查检测也存在过度诊断的风险。最后，没有专门的学会或预防服务小组目前建议进行常规筛查。初级保健医生和肾病学家应共同努力，识别有发生 ESRD 高风险的患者，并优化管理，以改善 CKD 患者的预后，而不是进行筛查。
