Management of Chronic Kidney Disease Stages 1–3
Clinical Bottom Line: Screening and Monitoring
For the analysis of studies regarding screening, the review was restricted to studies that enrolled adults who were without known chronic kidney disease (CKD), who were with or without recognized risk factors for CKD, and who were systematically screened for CKD. Randomized clinical trials (RCTs) that assessed the direct impact of systematic screening for CKD stages 1–3 on clinical outcomes and harms were sought. Exclusion criteria were as follows: nonadult population; study participants already diagnosed with CKD; not an RCT that assigned participants to systematic screening for CKD versus usual care; study followup durations less than 1 year; and sample size less than 1,000 randomized participants. When no relevant RCTs were identified, the search was expanded to include observational studies that could provide indirect evidence regarding these questions. There was no direct RCT evidence that addressed whether systematic screening of adults for CKD improves clinical outcomes or increases harms.
For the analysis of studies regarding monitoring, the review was restricted to studies that enrolled adults with CKD stages 1–3 who were systematically monitored for worsening kidney function and/or damage. RCTs were sought that assessed the direct impact of systematic monitoring of patients with CKD stages 1–3 for changes in kidney function and/or damage with usual care or an alternative CKD-monitoring regimen on clinical outcomes and harms. When no RCTs were identified that evaluated a CKD-monitoring intervention and reported clinical outcomes or harms, the search was expanded to include observational studies that could provide indirect evidence regarding possible monitoring benefits and harms. There was no direct RCT evidence about whether systematic monitoring of adults with CKD stages 1–3 for worsening kidney function or damage improves clinical outcomes.
Indirect evidence suggests that the potential harms from CKD screening and monitoring may include misclassification of patients with CKD, unnecessary tests and their associated adverse effects, psychological effects of being labeled with CKD, adverse effects associated with pharmacological treatments initiated or changed after a CKD diagnosis, and possible financial and insurance ramifications of a new CKD diagnosis.
- Fink HA, Ishani A, Taylor BC, et al. Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment. Comparative Effectiveness Review No. 37 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. HHSA 290-2007-10064-I). Rockville, MD: Agency for Healthcare Research and Quality; January 2012. AHRQ Publication No. 11(12)-EHC075-EF. Available at www.effectivehealthcare.ahrq.gov/ckd.cfm.
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