Routine Kidney Disease Screening Not Worthwhile, Experts Say
MONDAY April 30, 2012 -- As many as one in 10 Americans have chronic kidney disease, but most don't know it and for most it is not a problem, experts say.
However, there has been debate about whether healthy people should be screened for the condition. Now, a statement released Monday by the U.S. Preventive Services Task Force (USPSTF) says no.
"The evidence is insufficient to make a definitive recommendation about whether or not it's effective to screen healthy people for chronic kidney disease," said committee chairwoman Dr. Joy Melnikow, director of the Center for Healthcare Policy and Research at the University of California, Davis. "I was surprised how little evidence there was about screening healthy people."
There were no studies of the effectiveness of the blood or urine tests for creatinine, a marker of kidney function, in identifying who has chronic kidney disease, Melnikow said.
"In addition, we don't know if we intervene in healthy people with chronic kidney disease, if intervention would change its course," she noted.
Most chronic kidney disease is mild and asymptomatic, Melnikow said. "The rate of chronic kidney disease increases with age and, fortunately, for most people it doesn't affect them. But, in some people, it progresses to serious chronic disease, which can require dialysis," she explained.
The USPSTF statement also calls for studies on identifying and treating chronic kidney disease, she added.
"This statement only relates to screening healthy people, not to those at high risk for kidney disease such as people with diabetes or high blood pressure," Melnikow stressed.
Dr. Ajay Singh, clinical chief of the renal division and director of dialysis at Brigham and Women's Hospital in Boston, said that "the key point that the USPSTF makes is that their recommendation of not screening patients for chronic kidney disease applies to asymptomatic patients without risk factors."
The statement does acknowledge that there is evidence to support screening of high-risk groups, Singh added.
"The real message is that, sadly, we have only a limited toolbox of interventions to prevent progression of kidney disease once we identify someone with chronic kidney disease. Yes, we can debate who should or should not be screened, but what we really need are better interventions," Singh said.
Another expert, Dr. David Roth, clinical director of the division of nephrology and hypertension at the University of Miami Miller School of Medicine, added that "the evidence is not there that large-scale screening of asymptomatic patients, especially elderly patients, is going to change the outcome for that patient."
Roth agreed that people in high-risk populations, such as those with diabetes and/or high blood pressure, and blacks, should be screened.
"Kidney disease tends to be a silent disease until it's in much more advanced stages. For years, one can have kidney disease and not have a clue, and you can lose a great percentage of kidney function before it's finally picked up," Roth said.
Because most people lose kidney function with age, Roth thinks mass screening of healthy people would find a lot of kidney disease, but that would only worry people and wouldn't change their medical care.
A study published in the April 17 issue of the Annals of Internal Medicine came to the same conclusion.
In that study, researchers said that whether screening and monitoring people in the earlier stages of the disease provides a benefit just isn't clear.
For more on kidney disease, visit the U.S. National Library of Medicine.
Posted: April 2012