ACP issues clinical practice guideline on chronic kidney disease

ACP released a new clinical practice guideline this week on screening, monitoring and treatment of stage 1 to 3 chronic kidney disease (CKD).

The guideline was based on a systematic evidence review that evaluated the relevant English-language literature published from 1985 through November 2011. The clinical outcomes evaluated were all-cause mortality, cardiovascular mortality, composite renal outcomes, end-stage renal disease, quality of life, physical function and activities of daily living. The guideline was published online by Annals of Internal Medicine on Oct. 22.

ACP's recommendations are as follows:

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

The guideline authors also gave advice to clinicians on provision of high-value care in this population, noting that no evidence shows that screening improves clinical outcomes in adults without risk factors and that there is no proven benefit of screening in adults already taking ACE inhibitors or angiotensin II receptor blockers for microalbuminuria.

“In the absence of evidence that screening improves clinical outcomes, testing will add costs, owing to both the screening test and to additional follow-up tests (including those resulting from false-positive findings), increased medical visits, and costs of keeping or maintaining health insurance,” the guideline authors concluded.