Screening for chronic kidney disease: a systematic review of emerging evidence and perspectives

OBJECTIVE: The study aims to summarize the most recent evidence on the cost-effectiveness of chronic kidney disease (CKD) screening, identify the most cost-effective strategies under various conditions, and compare methodologies used in current health economics evaluations. The findings provide insights to support the implementation of appropriate screening strategies, particularly in low- and middle-income countries. METHODS: The final search was conducted between January 1, 2010, and July 1, 2024. Studies were screened for inclusion, and data were extracted, recalculated, and subjected to quality assessment. RESULTS: Of the 786 articles identified, 24 studies met the inclusion criteria. The probability of screening being cost-effective was 100% for diabetic populations, 75% for those with hypertension, and 72% for the general population. Key drivers of the cost-effectiveness models included drug efficacy, discount rates, and CKD progression probabilities. For diabetic populations, initiating at around age 50 with intervals of 5 to 10 years was generally found to be appropriate. The overall quality of the included studies was high. CONCLUSIONS: CKD screening is cost-effective in high-risk groups such as those with diabetes or hypertension, while general population screening depends on prevalence, methods, and frequency. In resource-limited settings, phased implementation starting with high-risk groups, integration into existing care pathways, and pilot programs using digital tools may enhance feasibility. Future research should refine optimal methods, timing, and intervals, and compare multiple strategies rather than only against standard care.