Little evidence on screening for CKD, USPSTF says

The current evidence is insufficient to determine whether asymptomatic patients should be screened for chronic kidney disease (CKD), according to a new recommendation from the U.S. Preventive Services Task Force (USPSTF).

The USPSTF statement was published online Aug. 28 Annals of Internal Medicine. The recommendation is focused only on screening asymptomatic individuals and does not apply to testing for and monitoring CKD for the purpose of chronic disease management (including monitoring patients with diabetes or hypertension), the task force noted. Evidence shows that CKD treatments for patients with diabetes reduce risk, and although there is limited evidence on whether CKD screening in patients with isolated hypertension changes treatment decisions, several organizations recommend screening.

The benefits of testing asymptomatic patients are uncertain because no studies have evaluated the sensitivity and specificity of one-time testing by either serum creatinine or urine albumin. There is also no evidence on the benefits of early CKD treatment in persons without diabetes or hypertension. However, convincing evidence shows that medications used to treat early CKD may have adverse effects, the USPSTF wrote. Other potential harms include adverse effects from venopuncture and psychological effects of labeling a person with CKD.

The task force noted that serum creatinine testing is widely done for various reasons in clinical practice, but that no guidelines from primary care organizations recommend screening all adults for CKD. They called for additional research, including on sensitivity and specificity of testing and possible interventions to reduce end-stage kidney disease among African-Americans.