New AAFP, USPSTF Guidance

Evidence Lacking to Support Screening Asymptomatic Adults for Chronic Kidney Disease

August 29, 2012 11:00 am Matt Brown

Insufficient evidence exists to assess the balance of benefits and harms of routine screening for chronic kidney disease (CKD) in asymptomatic adults, according to the AAFP and the U.S. Preventive Services Task Force( (USPSTF).

[Illustration of a kidney]

The guidance applies only to asymptomatic adults, family physician and USPSTF member Joy Melnikow, M.D., M.P.H., of Sacramento, Calif., told AAFP News Now. It does not apply to testing for and monitoring CKD for the purposes of chronic disease management, including testing and monitoring patients with diabetes or hypertension, which often is associated with CKD.

"This statement refers to the lack of evidence for the practice of getting renal function tests or urinalysis as a routine screening test," said Melnikow, referring to the fact that tests commonly used for CKD screening include creatinine-derived estimates of glomerular filtration rate and urine testing for albumin. "Obviously these tests are used frequently in managing symptoms and managing chronic diseases, but that is a different situation."

"This is a 'More research is really needed' statement," she said. "We do not have sufficient evidence to know if there is any benefit, or any harm, to screening healthy adults without hypertension or diabetes to see if they have abnormal renal function tests."

According to the USPSTF statement, Medicare data show that 48 percent of patients with CKD (excluding end-stage renal disease) have diabetes, and 91 percent have hypertension.

Early CKD treatment, which consists of ACE inhibitors, angiotensin II–receptor blockers, lipid-lowering agents and diet modification, is generally targeted to comorbid medical conditions to reduce complications and disease progression. In addition to diabetes and hypertension, cardiovascular disease also is a common comorbid condition, affecting 46 percent of patients with CKD. Other risk factors for CKD include older age, obesity and family history.

According to the task force, there are no studies on the benefits of early treatment in people without diabetes or hypertension. Individuals who have positive results on a screening test for CKD, but who do not have the disease, may experience the harms associated with interventions and treatments without the potential for benefit.