Korsa Ayana, Tesfaye Wubshet, Sud Kamal, Krass Ines, Castelino Ronald L
Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
School of Pharmacy, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia.
Kidney Med. 2025 Feb 12;7(4):100979. doi: 10.1016/j.xkme.2025.100979. eCollection 2025 Apr.
RATIONALE & OBJECTIVE: Kidney failure can be prevented or delayed if chronic kidney disease (CKD) is detected and treated early. Targeted screening has been shown effective in detecting CKD worldwide, but a recently updated summary of evidence is lacking. We synthesized up-to-date evidence of the effectiveness of risk factor-based screening for the early detection of CKD among adults in primary care.
We retrieved articles from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus. Relevant gray literature and hand-searching bibliographies of key articles were also performed.
SETTING & STUDY POPULATIONS: Adult patients (age ≥ 18 years) with at least 1 known CKD risk factor in primary care.
Prospective studies applying CKD screening in adults based on at least 1 CKD risk factor.
Data were abstracted from full texts and the risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools.
No meta-analysis was conducted.
In total, 24 studies from 11 countries fulfilled the inclusion criteria. Diverse screening tests, CKD definitions, formulas for estimating kidney function, and positive screening test cutoffs were used. Most studies (n = 22) employed estimated glomerular filtration rate (eGFR), albumin-creatinine ratio (ACR) (n = 14), and dipstick urinalysis (n = 9) for screening. The prevalence of reduced kidney function and/or kidney damage was between 2.9% and 56%, and confirmed CKD varied from 4.4% to 17.1%. Increased patient referrals and physician visits, higher patient satisfaction, and some form of patient willingness to pay for the services were reported because of screening.
Meta-analysis was not conducted, and the findings might not be generalized to resource-limited settings.
Risk factor-based screening effectively identifies a substantial proportion of people with undiagnosed CKD, but there is still scope for improvement. We recommend future studies have robust designs and multidimensional interventions to establish the effectiveness of targeted CKD screening in primary care.
如果能早期发现并治疗慢性肾脏病（CKD），肾衰竭是可以预防或延缓的。有针对性的筛查已被证明在全球范围内对检测CKD有效，但目前缺乏最新的证据总结。我们综合了最新证据，以探讨基于风险因素的筛查在初级保健中对成人早期检测CKD的有效性。
我们从Medline、Embase、护理及相关健康文献累积索引（CINAHL）、科学引文索引（Web of Science）和Scopus中检索文章。还查阅了相关灰色文献并手工检索了关键文章的参考文献。
初级保健中至少有1个已知CKD风险因素的成年患者（年龄≥18岁）。
基于至少1个CKD风险因素对成人进行CKD筛查的前瞻性研究。
从全文中提取数据，并使用乔安娜·布里格斯研究所的批判性评价工具评估偏倚风险。
未进行荟萃分析。
来自11个国家的24项研究符合纳入标准。研究使用了多种筛查测试、CKD定义、估算肾功能的公式以及阳性筛查测试临界值。大多数研究（n = 22）采用估算肾小球滤过率（eGFR）、白蛋白肌酐比值（ACR）（n = 14）和尿试纸分析（n = 9）进行筛查。肾功能降低和/或肾脏损伤的患病率在2.9%至56%之间，确诊的CKD患病率在4.4%至17.1%之间。报告称，由于筛查，患者转诊和医生就诊增加，患者满意度提高，并且患者有某种形式的付费意愿。
未进行荟萃分析，研究结果可能无法推广到资源有限的环境。
基于风险因素的筛查能有效识别出相当比例未被诊断的CKD患者，但仍有改进空间。我们建议未来的研究采用稳健的设计和多维干预措施，以确定有针对性的CKD筛查在初级保健中的有效性。
