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Added value of screening for CKD among the elderly or persons with low socioeconomic status
Priya Vart1, Sjimen A Reijneveld2, Ute Bültmann2
1Department of Health Sciences, Community and Occupational Medicine, and p.vart@umcg.nl.
Insights
Screening for chronic kidney disease (CKD) by including individuals with low socioeconomic status (SES) alongside traditional high-risk groups is more effective. This approach identifies more CKD patients at higher risk for cardiovascular disease (CVD) events and kidney function decline.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Chronic kidney disease (CKD) affects a significant portion of the population.
- Early detection of CKD is crucial for managing associated cardiovascular disease (CVD) risks and slowing renal function decline.
- Current screening methods primarily target individuals with known diabetes, hypertension, or CVD history.
Purpose of the Study:
- To compare the effectiveness of three CKD screening approaches.
- To identify which approach best detects CKD cases and patients with elevated risks of CVD events and renal function decline.
- To evaluate the impact of including elderly or low socioeconomic status (SES) individuals in screening protocols.
Main Methods:
- A cohort of 3411 individuals from the general population in The Netherlands was studied.
- Screening approaches included: 1) traditional high-risk groups, 2) traditional high-risk groups + elderly (>60 years), and 3) traditional high-risk groups + low SES individuals (primary school education or less).
- Participants were followed for 9.4 years to assess CKD diagnosis, incident CVD events, and renal function decline.
Main Results:
- Approach 3 (including low SES individuals) detected 51% of CKD cases, compared to 36% in Approach 1 and 59% in Approach 2.
- Individuals identified through Approach 3 showed a higher hazard ratio for incident CVD events (2.31) compared to Approach 2 (1.87).
- Both Approach 2 and 3 identified CKD patients with significant rates of renal function decline (-1.37 and -1.41 ml/min/year, respectively).
Conclusions:
- Screening strategies that incorporate individuals with low socioeconomic status (SES) are more effective in detecting CKD cases.
- Including low SES individuals, rather than elderly individuals, in addition to traditional risk groups, identifies more CKD patients at higher risk for future CVD events and renal function decline.
Background And Objective:
Three screening approaches were compared for their ability to detect CKD cases, and identify patients with CKD who have a higher rate of incident cardiovascular disease (CVD) events and renal function decline. Approach 1 was the traditional CKD screening approach, targeting only individuals with known diabetes, hypertension, or CVD history. Approach 2 was defined as Approach 1+elderly, and Approach 3 as Approach 1+low-socioeconomic status (SES) individuals.
Design, Setting, Participants, & Measurements:
Data on 3411 individuals from the general population in The Netherlands were examined. Individuals aged >60 years were classified as elderly. Persons with low SES was defined as those with primary school or below primary school education. CKD was diagnosed during outpatient clinic visits. Individuals were followed for 9.4±2.6 years during four screening rounds.
Results:
At baseline, 16%, 29%, and 25% of the general population was to be screened and 36%, 59%, and 51% of the CKD (n=263) cases were detected in Approaches 1, 2, and 3, respectively. The numbers of individuals needed to screen to detect one CKD case were 5.6 in Approach 1 and 6.5 each in Approach 2 and 3. In Approach 2 the hazard ratio for incident CVD events was 1.87 (95% confidence interval [95% CI], 1.35 to 2.61) in detected and 1.92 (95% CI, 1.01 to 3.64) in undetected CKD cases compared with persons without CKD, whereas in Approach 3 these values were 2.31 (95% CI, 1.64 to 3.25) and 1.28 (95% CI, 0.77 to 2.13), respectively. In Approach 2, the rate of renal function decline was -1.37 ml/min per 1.73 m(2) per year in detected and -1.13 ml/min per 1.73 m(2) per year in undetected CKD cases. In Approach 3, these figures were -1.41 and -1.14 ml/min per 1.73 m(2) per year, respectively.
Conclusions:
Adding persons with low SES, rather than adding elderly persons, to the traditional high-risk groups may help detect more persons with CKD who have a higher rate of future CVD events and renal function decline.
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