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Opportunistic in-hospital screening for kidney disease using the Kidney Health Check
Nathan A Hewitt1, Grahame J Elder
1St George Hospital, Sydney, New South Wales, Australia; University of Notre Dame, Sydney, New South Wales, Australia.
Insights
Early kidney disease screening (KHC) in hospital inpatients is feasible and cost-effective. Most patients had abnormalities detected, highlighting the need for KHC in routine discharge planning to improve health outcomes.
Area of Science:
- Nephrology
- Public Health
- Health Services Research
Background:
- Chronic kidney disease (CKD) poses a significant public health challenge, with early detection crucial for preventing morbidity and mortality.
- The Kidney Health Check (KHC), comprising blood pressure (BP), estimated glomerular filtration rate (eGFR), and urinalysis (UA), is a standard CKD screening tool.
- The implementation and cost-effectiveness of KHC screening for high-risk hospital inpatients remain largely unknown.
Purpose of the Study:
- To determine the proportion of hospital inpatients tested for all KHC components during admission.
- To compare the estimated costs of in-hospital KHC screening and follow-up with existing screening programs.
Main Methods:
- A retrospective audit of consecutively admitted adult patients was performed.
- The frequency of BP, eGFR, and UA testing was recorded.
- Published data were used to estimate the costs and benefits of KHC components.
Main Results:
- Two hundred patients (median age 75) were assessed; all had BP and eGFR documented, while 55% had a UA, completing the KHC.
- Abnormalities were detected in 71% of patients; only 31% of those with eGFR <60 mL/min/1.73 m² had a recorded CKD diagnosis.
- In-hospital KHC screening costs were estimated to be lower than current Australian screening programs.
Conclusions:
- Hospital inpatients frequently undergo a complete KHC, with most showing abnormalities.
- Opportunistic inpatient KHC screening has minimal impact on hospital costs but offers substantial health benefits.
- Integrating the KHC into routine discharge documentation is recommended.
Background:
Chronic kidney disease (CKD) is a major public health issue and early detection may prevent morbidity and mortality. Screening for CKD is simply assessed using the Kidney Health Check (KHC), a compilation of blood pressure (BP), estimated glomerular filtration rate (eGFR) and urinalysis (UA). KHC screening of high risk hospital inpatients is recommended, but its implementation and cost-effectiveness is unknown.
Aims:
We aimed to determine the proportion of patients currently tested for all components of the KHC during an acute hospital admission, and to compare the estimated costs of screening and subsequent follow-up with other screening programs.
Methods:
A retrospective audit was conducted of consecutively admitted adult patients, and the frequency of BP, eGFR and UA testing recorded. Using published data, the likely costs and benefits of components of the KHC were estimated.
Results:
Two hundred patients (median age 75 years, range 20-98) were assessed. All had a documented BP and eGFR, and 55% had a UA, representing a complete KHC. Of the total, 141 (71%) had one or more abnormalities detected, and of 71 with an eGFR <60 mL/min per 1.73 m(2) , only 22 (31%) had a recorded diagnosis of CKD. Estimated costs of opportunistic in-hospital KHC screening are below those of current Australian screening programs.
Conclusions:
Hospital in-patients frequently have a full KHC and most have abnormalities detected. Opportunistic inpatient KHC screening would have little impact on hospital costs, but may result in significant health benefits. The KHC should be included in routine discharge documentation.
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