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Public Policy Series
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Screening for CKD: A Pro and Con Debate

Alan S. Kliger
CJASN November 2014, 9 (11) 1987; DOI: https://doi.org/10.2215/CJN.08990914
Alan S. Kliger
Yale School of Medicine, Yale New Haven Health System, New Haven, Connecticut
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  • CKD
  • screening
  • population testing

Should doctors screen asymptomatic patients for CKD? Screening for a disease is useful if it leads to improved outcomes for those so identified. Screening also carries risks: false-positive tests may cause anxiety and unnecessary procedures. Overdiagnosis is a risk (i.e., identifying individuals with a positive screen who have no inherent risk of progression or debility from that condition). False-negative tests can give false reassurance when disease progression occurs nonetheless.

Debates rage over screening women for breast cancer with mammography or screening men for prostate cancer with prostate-specific antigen testing. Do the potential harms outweigh the benefits? One article is titled “Mammography screening in Norway caused substantial overdiagnosis and did not reduce late-stage breast cancer” (1). The American Urological Association guideline on prostate cancer detection recommends against routine prostate-specific antigen screening for men younger than 55 years old at average risk. A subsequent study showed that men no longer recommended for screening had equivalent if not worse outcomes from prostate cancer than those with screening (2).

Does population screening with serum creatinine and urine protein testing lead to improved outcomes without undue harm?

In 2012, the US Preventive Services Task Force concluded that the evidence is insufficient to assess the balance of benefits and harms of routine screening for CKD in asymptomatic adults (3). In 2013, the American College of Physicians recommended against screening for CKD in asymptomatic adults without risk factors for CKD (4). In sharp contrast, the American Society of Nephrology strongly recommends regular screening for kidney disease, regardless of an individual’s risk factors (5). The National Kidney Foundation and the Renal Physicians Association recommend that health care professionals test patients in specific high-risk groups for CKD—particularly those with diabetes or high BP (6). Do possible harms of screening outweigh potential benefits?

The debate follows. Qaseem et al. (7) argue that screening for CKD does not improve important clinical outcomes. Therefore, Qaseem et al. (7) argue against screening asymptomatic adults as well as adults with diabetes if they are already taking an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker. On the other side of the debate, Berns (8) argues for a thoughtful and selective approach to CKD screening, including screening those with diabetes, hypertension, other CKD risk factors, or family history of hypertension, diabetes, or CKD.

Do you screen your patients for CKD? Do you think routine screening should be done for asymptomatic adults with or without diabetes or hypertension? See what you think after reading this debate.

Disclosures

None.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Copyright © 2014 by the American Society of Nephrology

References

  1. ↵
    1. Jørgensen KJ
    : Mammography screening in Norway caused substantial overdiagnosis and did not reduce late-stage breast cancers. Evid Based Med 18: e17, 2013pmid:22923706
    OpenUrlFREE Full Text
  2. ↵
    1. Auffenberg GB,
    2. Meeks JJ
    : Application of the 2013 American Urological Association early detection of prostate cancer guideline: Who will we miss? World J Urol 32: 959–964, 2014pmid:24946729
    OpenUrlCrossRefPubMed
  3. ↵
    1. Moyer VA,
    2. US Preventive Services Task Force
    : Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 157: 567–570, 2012pmid:22928170
    OpenUrlCrossRefPubMed
  4. ↵
    1. Qaseem A,
    2. Hopkins RH Jr..,
    3. Sweet DE,
    4. Starkey M,
    5. Shekelle P,
    6. Clinical Guidelines Committee of the American College of Physicians
    : Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians. Ann Intern Med 159: 835–847, 2013pmid:24145991
    OpenUrlCrossRefPubMed
  5. ↵
    ASN: ASN Emphasizes Need for Early Detection of Kidney Disease, a Silent Killer. Available at: http://www.asn-online.org/news/2013/ASN_COMM_ACP_Screening_Response_102213_R12.pdf. Accessed September 9, 2014
  6. ↵
    National Kidney Foundation: Renal Physicians Association urge screening for those at risk for kidney disease. Available at http://www.kidney.org/news/newsroom/nr/NKF-RPA-Urge-Screening-for-atRisk-KD Accessed September 9, 2014
  7. ↵
    1. Qaseem
    : Clin J Am Soc Nephrol 9: 1993–1995, 2014pmid:24145991
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Berns
    : Clin J Am Soc Nephrol 9: 1988–1992, 2014pmid:24145991
    OpenUrlAbstract/FREE Full Text
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Clinical Journal of the American Society of Nephrology: 9 (11)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 11
November 07, 2014
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Screening for CKD: A Pro and Con Debate
Alan S. Kliger
CJASN Nov 2014, 9 (11) 1987; DOI: 10.2215/CJN.08990914

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Screening for CKD: A Pro and Con Debate
Alan S. Kliger
CJASN Nov 2014, 9 (11) 1987; DOI: 10.2215/CJN.08990914
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More in this TOC Section

  • New Organ Allocation System for Combined Liver-Kidney Transplants and the Availability of Kidneys for Transplant to Patients with Stage 4–5 CKD
  • Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition
  • New Opportunities for Funding Dialysis-Dependent Undocumented Individuals
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