Abstract
Background
Targeted screening interventions for chronic kidney disease (CKD) are increasingly being implemented in various community settings. However, the overall success of these programs is uncertain. Therefore, the aim of this review is to determine whether targeted screening is effective in detecting people with undiagnosed CKD.
Methods
We performed a systematic literature review, and included studies of targeted screening intervention implemented in any community-based setting. Studies were required to have targeted people aged ≥18 years, and multiple CKD risk factors from the following: diabetes, hypertension, cardiovascular disease and family history of kidney disease. The outcome measures were percentages of participants with positive screening test results and diagnosed with CKD at follow-up.
Results
Nine studies met the inclusion criteria. Eight studies reported the percentage of participants with positive screening test results, which ranged from 7 to 60.3%. Only two studies repeated the diagnostic tests to detect CKD, and confirmed the chronicity of CKD in 20.5 and 17.1% of screened participants. The most commonly used screening tests were albumin creatinine ratio (≥3.4 mg/mmol), and estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m2). All studies classified CKD stage 3 and above based on eGFR alone. Characteristics of the interventions responsible for inconsistencies in the outcome measures included CKD risk factors targeted, and screening tests used to detect CKD.
Conclusions
This systematic review found significant variation in the methods that were used to detect CKD, with the majority of studies reporting results based on only single albuminuria or eGFR values. Future targeted screening programs should appropriately use the 2012 KDIGO guidelines in order to detect CKD, which is necessary to determine the benefit of these programs when implemented in community-settings.
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References
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139(2):137–147
Mathew T, Corso O (2009) Review article: Early detection of chronic kidney disease in Australia: which way to go? Nephrology (Carlton) 14 (4):367–373. doi:10.1111/j.1440-1797.2009.01113.x
Smart NA, Titus TT (2011) Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med 124(11):1073–1080.e1072. doi:10.1016/j.amjmed.2011.04.026
Lopez-Vargas PA, Tong A, Sureshkumar P, Johnson DW, Craig JC (2013) Prevention, detection and management of early chronic kidney disease: a systematic review of clinical practice guidelines. Nephrology (Carlton) 18 (9):592–604. doi:10.1111/nep.12119
Komenda P, Ferguson TW, Macdonald K, Rigatto C, Koolage C, Sood MM, Tangri N (2014) Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis 63(5):789–797. doi:10.1053/j.ajkd.2013.12.012
Bang H, Vupputuri S, Shoham DA, Klemmer PJ, Falk RJ, Mazumdar M, Gipson D, Colindres RE, Kshirsagar AV (2007) SCreening for occult renal disease (SCORED): a simple prediction model for chronic kidney disease. Arch Intern Med 167(4):374–381. doi:10.1001/archinte.167.4.374
Halbesma N, Jansen DF, Heymans MW, Stolk RP, de Jong PE, Gansevoort RT (2011) Development and validation of a general population renal risk score. Clin J Am Soc Nephrol 6(7):1731–1738. doi:10.2215/cjn.08590910
O’Seaghdha CM, Lyass A, Massaro JM, Meigs JB, Coresh J, D’Agostino RB Sr, Astor BC, Fox CS (2012) A risk score for chronic kidney disease in the general population. Am J Med 125(3):270–277. doi:10.1016/j.amjmed.2011.09.009
Collins G, Altman D (2012) Predicting the risk of chronic kidney disease in the UK: an evaluation of QKidney(R) scores using a primary care database. Br J Gen Pract 62(597):e243–e250. doi:10.3399/bjgp12X636065
De Almeida EAF, Lavinas C, Teixeira C, Raimundo M, Nogueira C, João Melo M, Ferreira M, Sampaio A, Da Silva Henriques I, Teixeira C, Almeida S, Gomes Da Costa A, Leal M (2012) Evaluation of an instrument for screening patients at risk for chronic kidney disease: testing SCORED (screening for occult renal disease) in a Portuguese population. Kidney Blood Press Res 35(6):568–572
Glassock RJ (2010) Is the presence of microalbuminuria a relevant marker of kidney disease? Curr Hypertens Rep 12(5):364–368. doi:10.1007/s11906-010-0133-3
Glassock RJ (2014) Con: thresholds to define chronic kidney disease should not be age dependent. Nephrol Dial Transplant 29 (4):774–779; discussion 779–782. doi:10.1093/ndt/gft306
Inker LA, Tighiouart H, Aspelund T, Gudnason V, Harris T, Indridason OS, Palsson R, Shastri S, Levey AS, Sarnak MJ (2015) Lifetime risk of stage 3–5 CKD in a community-based sample in iceland. Clin J Am Soc Nephrol CJASN 10(9):1575–1584. doi:10.2215/CJN.00180115
Mills KT, Xu Y, Zhang W, Bundy JD, Chen CS, Kelly TN, Chen J, He J (2015) A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int 88(5):950–957. doi:10.1038/ki.2015.230
Brown WW, Peters RM, Ohmit SE, Keane WF, Collins A, Chen SC, King K, Klag MJ, Molony DA, Flack JM (2003) Early detection of kidney disease in community settings: the kidney early evaluation program (KEEP). Am J Kidney Dis 42 (1 SUPPL. 2):22–35
McGill JB, Brown WW, Chen SC, Collins AJ, Gannon MR (2004) Kidney early evaluation program (KEEP). Findings from a community screening program. Diabetes Educ 30 (2):196–198, 200–202, 206
Collins AJ, Li S, Chen SC, Vassalotti JA (2008) Participant follow-up in the kidney early evaluation program (KEEP) after initial detection. Am J Kidney Dis 51 (4 SUPPL. 2):S69-S76
Jurkovitz CT, Qiu Y, Wang C, Gilbertson DT, Brown WW (2008) The kidney early evaluation program (KEEP): program design and demographic characteristics of the population. Am J Kidney Dis 51(4 Suppl 2):S3-S12. doi:10.1053/j.ajkd.2007.12.022
Harward DH, Bomback AS, Jennette CE, Amamoo MA, Falk R (2009) The kidney education outreach program’s community-based screenings: participants’ demographics and screening results. N C Med J 70(6):507–512
Mathew TH, Corso O, Ludlow M, Boyle A, Cass A, Chadban SJ, Joyner B, Shephard M, Usherwood T (2010) Screening for chronic kidney disease in Australia: a pilot study in the community and workplace. Kidney Int Suppl (116):S9-16
Obrador GT, García-García G, Villa AR, Rubilar X, Olvera N, Ferreira E, Virgen M, Gutiérrez-Padilla JA, Plascencia-Alonso M, Mendoza-García M, Plascencia-Pérez S (2010) Prevalence of chronic kidney disease in the kidney early evaluation program (KEEP) México and comparison with KEEP US. Kidney Int Suppl (116):S2-8
National Kidney Foundation American Journal of Kidney Disease-KEEP 2012 Annual Data Reports. Summary Figures, Reference Tables, and Analytical Methods. (2012). https://www.kidney.org/news/keep/KEEPDataReports. Accessed 26 April 2016
Barahimi H, Aghighi M, Aghayani K, Foroushani AR (2014) Chronic kidney disease management program in Shahreza, Iran. Iran J Kidney Dis 8(6):450–456
Al Hamarneh YN, Hemmelgarn B, Curtis C, Balint C, Jones CA, Tsuyuki RT (2016) Community pharmacist targeted screening for chronic kidney disease. Can Pharm J 149(1):13–17
Galbraith LE, Ronksley PE, Barnieh LJ, Kappel J, Manns BJ, Samuel SM, Jun M, Weaver R, Valk N, Hemmelgarn BR (2016) the see kidney disease targeted screening program for CKD. Clin J Am Soc Nephrol 11(6):964–972. doi:10.2215/cjn.11961115
Brown WW, Collins A, Chen SC, King K, Molony D, Gannon MR, Politoski G, Keane WF (2003) Identification of persons at high risk for kidney disease via targeted screening: the NKF Kidney Early Evaluation Program. Kidney Int Suppl (83):S50-55. doi:10.1046/j.1523-1755.63.s83.11.x
Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. doi:10.1016/j.ijsu.2010.02.007
Sterne JAC, Higgins JPT, Reeves BC. A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions (ACROBAT-NRSI), Version1.0. 0, 24 September 2014. http://www.riskofbias.info. Accessed 12 July 2016
Berns JS (2014) Routine screening for CKD should be done in asymptomatic adults… selectively. Clin J Am Soc Nephrol 9(11):1988–1992
Carroll MF, Temte JL (2000) Proteinuria in adults: a diagnostic approach. Am Fam Physician 62(6):1333–1340
White SL, Polkinghorne KR, Atkins RC, Chadban SJ (2010) Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR estimating equations: the AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. Am J Kidney Dis 55(4):660–670. doi:10.1053/j.ajkd.2009.12.011
Glassock RJ, Winearls C (2008) Screening for CKD with eGFR: doubts and dangers. Clin J Am Soc Nephrol 3(5):1563–1568
Rule AD, Bailey KR, Schwartz GL, Khosla S, Lieske JC, Melton LJ 3rd (2009) For estimating creatinine clearance measuring muscle mass gives better results than those based on demographics. Kidney Int 75(10):1071–1078. doi:10.1038/ki.2008.698
American Journal of Kidney Disease-KEEP: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. (2012). Kidney Int Suppl (3):1–163
Benghanem Gharbi M, Elseviers M, Zamd M, Belghiti Alaoui A, Benahadi N, Trabelssi EH, Bayahia R, Ramdani B, De Broe ME (2016) Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid “over”- and “under”-diagnosis of CKD. Kidney Int 89(6):1363–1371
Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Gonzalez AO, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W, Stel VS (2015) Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrology dialysis. Transplantation 30(Suppl 4):iv6–iv16. doi:10.1093/ndt/gfv131
Eriksen BO, Ingebretsen OC (2006) The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int 69(2):375–382. doi:10.1038/sj.ki.5000058
Jaar BG, Khatib R, Plantinga L, Boulware LE, Powe NR (2008) Principles of screening for chronic kidney disease. Clin J Am Soc Nephrol 3(2):601–609. doi:10.2215/cjn.02540607
Acknowledgements
Miss Gheewala acknowledges librarian Michaela Venn for guidance with conducting the literature search for review.
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G. M. Peterson and R. L. Castelino contributed equally to the manuscript.
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Gheewala, P.A., Zaidi, S.T.R., Jose, M.D. et al. Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review. J Nephrol 31, 27–36 (2018). https://doi.org/10.1007/s40620-017-0375-0
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DOI: https://doi.org/10.1007/s40620-017-0375-0