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David Plaut: Off the Cuff

The Heated CKD Debate

Published March 4, 2014 12:25 PM by David Plaut

Whether to screen for chronic kidney disease (CKD) is being rather heatedly debated these days. This is not a trivial question -- one in 10 American adults, more than 20 million, have some level of CKD, making CKD the eighth leading cause of death in the US. On one side is the American College of Physicians (ACP) which recommends:

  1. ACP recommends against screening for CKD in asymptomatic adults without risk factors for CKD. (Grade: weak recommendation, low-quality evidence).
  2. ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker. (Grade: weak recommendation, low-quality evidence).
  3. ACP recommends that clinicians select pharmacologic therapy (high-quality evidence) in patients with hypertension and stage 1 to 3 chronic kidney disease. (Grade: strong recommendation).
  4. ACP recommends that clinicians choose statin therapy to manage elevated low-density lipoprotein in patients with stage 1 to 3 chronic kidney disease. (Grade: strong recommendation, moderate-quality evidence).

On the other side the American Society of Nephrology (ASN) strongly disagrees. Their argument is that CKD is usually asymptomatic but once discovered, can be treated and, while not cured, can provide a better quality of life for some time. Blood and/or urine tests such as eGFR with cystatin or creatinine can often detect CKD in an early state.

The USPSTF has made the following comments: "There is no generally accepted risk assessment tool for CKD or risk for complications of CKD. Diabetes and hypertension are well-established risk factors with strong links to CKD. Other risk factors for CKD include older age, cardiovascular disease, obesity, and family history. While there is insufficient evidence to recommend routine screening, the tests often suggested for screening that are feasible in primary care. The USPSTF could not determine the balance between the benefits and harms of screening for CKD in asymptomatic adults."

posted by David Plaut


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