Routine screening for CKD should be done in asymptomatic adults... selectively

Area of Science:

• Nephrology
• Public Health
• Internal Medicine

Background:

• Chronic kidney disease (CKD) presents a significant public health challenge, causing morbidity, reduced quality of life, and increased healthcare costs.
• The long asymptomatic phase of CKD highlights the potential value of early detection through screening.
• Recent guidelines recommending against CKD screening in asymptomatic adults without risk factors have intensified discussions on the topic.

Purpose of the Study:

• To evaluate the clinical utility and cost-effectiveness of CKD screening in asymptomatic individuals.
• To address the ongoing debate surrounding CKD screening recommendations.
• To emphasize the benefits of selective screening in at-risk populations.

Main Methods:

• This analysis synthesizes current evidence and professional society guidelines regarding CKD screening.
• It considers the cost-effectiveness and clinical value of a selective screening approach.
• The study reviews the rationale for screening in individuals with risk factors like diabetes, hypertension, and specific racial/ethnic backgrounds.

Main Results:

• Despite a lack of randomized controlled trial evidence, selective CKD screening in at-risk asymptomatic individuals is deemed cost-effective and clinically valuable.
• Nephrology professional societies recommend screening for early identification and management.
• Screening aids in diagnosing CKD etiology, preventing progression, and reducing associated risks.

Conclusions:

• A thoughtful and selective approach to CKD screening is clinically valuable and cost-effective for at-risk asymptomatic individuals.
• Screening facilitates early management, diagnosis of etiology, and prevention of CKD progression and complications.
• It helps mitigate risks of acute kidney injury (AKI), incorrect drug dosing, and nephrotoxic injury.