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Management of Chronic Kidney Disease Stages 1–3

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Clinical Questions Addressed in the CER: Treatments for CKD Stages 1–3

The comparative effectiveness review (CER) analysis of treatment options for adults with chronic kidney disease (CKD) stages 1–3 was undertaken to determine the answers to these questions related to benefits and adverse effects of treatment:

  • Among adults with chronic kidney disease (CKD) stages 1–3, whether detected by systematic screening or as part of routine care, what direct evidence is there that treatment improves clinical outcomes?
  • Does the presence of CKD modify the likelihood of improvement in clinical outcomes associated with treatment of vascular disease or vascular risk factors?
  • Among adults with CKD, what patient factors modify the association of specific treatments with improved clinical outcomes?
  • Among adults with CKD stages 1–3, whether detected by systematic screening or as part of routine care, what harms result from treatment?
  • Does the presence of CKD modify the likelihood of harms associated with treatment of vascular disease or of vascular risk factors?
  • How do patient factors and CKD severity/stage modify the association of CKD treatment with harms?

The review was restricted to randomized controlled trials that enrolled adults with CKD stages 1–3. Studies of both CKD-specific and CKD-nonspecific treatments were included. Studies were sought that compared active treatment of patients with CKD stages 1–3 with placebo, usual care/no treatment, or with other active treatments, including combination treatment and comparisons with the same active treatments using different dose levels or targeting different treatment thresholds. The review was restricted to studies that reported clinical outcomes or harms.