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Factors Affecting Renal Clearance: Renal Impairment

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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Dialysis

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Balancing Efficiency and Equity in Population-Wide CKD Screening.

Marika M Cusick¹, Rebecca L Tisdale^2,3, Alyce S Adams^1,4

¹Department of Health Policy, School of Medicine, Stanford University, Stanford, California.

JAMA Network Open

|April 14, 2025

Summary

This summary is machine-generated.

Population-wide chronic kidney disease (CKD) screening from ages 55-75 is cost-effective and reduces health disparities. Early screening benefits non-Hispanic Black adults most, improving outcomes across all racial and ethnic groups.

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Area of Science:

Nephrology
Public Health
Health Economics

Background:

Sodium-glucose cotransporter 2 (SGLT2) inhibitors offer new CKD treatment avenues.
Population-wide CKD screening value is established, but racial/ethnic implications are unclear.

Purpose of the Study:

Evaluate health outcomes, costs, and cost-effectiveness of CKD screening across diverse racial and ethnic groups.
Assess the impact of SGLT2 inhibitors in conjunction with screening.

Main Methods:

Cost-effectiveness analysis using a decision-analytic Markov model.
Simulated CKD progression in US Hispanic, non-Hispanic Black, non-Hispanic White, and other racial/ethnic adult groups.
Incorporated SGLT2 inhibitor effectiveness data from clinical trials and real-world cost/mortality data.

Main Results:

Screening every 5 years (ages 55-75) with SGLT2 inhibitors reduced kidney failure and increased life-years across all groups.
Non-Hispanic Black adults showed the largest improvements; screening was most cost-effective for this group.
Screening from age 35 was cost-effective only for non-Hispanic Black adults.

Conclusions:

Population-wide CKD screening (ages 55-75) improves health, is cost-effective, and reduces disparities.
Earlier screening (age 35) offers additional benefits, particularly for non-Hispanic Black adults.
Screening strategies should consider age and race/ethnicity for optimal CKD management.