Delays in screening, diagnosis and monitoring are associated with worse clinical and economic outcomes for patients with chronic kidney disease: a narrative review

Chronic kidney disease (CKD) has substantial associated morbidity, mortality and healthcare costs that increase as CKD progresses. Despite newer, more effective treatments, the global burden of CKD continues to increase. To understand patterns of screening, diagnosis, monitoring and treatment in CKD and how earlier treatment initiation could help mitigate CKD burden. Targeted searches of bibliographic databases and grey literature sources identified studies published 2015–2025. Eligible evidence comprised observational studies on CKD screening and diagnosis rates, factors associated with delayed treatment initiation, clinical and economic burden of delayed diagnosis/treatment, and economic evaluations of population-based CKD screening. Thirty-five studies were synthesized narratively according to the CKD care pathway; no meta-analysis or formal quality assessment was conducted. Despite guideline recommendations, 19%–33% of patients in at-risk populations received neither kidney function nor albuminuria testing. Documented CKD diagnosis rates were often low, particularly in earlier stages. Documented CKD diagnosis was associated with increased monitoring and prescription fill rates, as well as slower decline of estimated glomerular filtration rate. Longer time to documented diagnosis and nephrology referral timing were associated with increased risk of kidney failure and cardiovascular events. Recent economic models that incorporated newer treatments and cardiovascular events generally produced found selected population-based screening strategies cost-effective. However, findings varied by target population, screening strategy/frequency, treatment, model assumptions, setting and willingness-to-pay threshold, and not all modelled scenarios were cost-effective. Results from observational studies suggest an association between earlier CKD diagnosis and greater use of appropriate monitoring and nephrology referral, which may facilitate timely intervention to slow progression, improving long-term outcomes. However, many patients remain undiagnosed despite available laboratory data. Improvements in risk-based testing, screening, diagnosis, monitoring and nephrology referral may help patients access effective treatments, but stronger comparative evidence is needed to establish their effects on clinical outcomes and costs. Although documented CKD diagnosis and nephrology referral have been associated with more favourable clinical and economic outcomes in observational studies, the proportion with a documented CKD diagnosis was generally low, and many patients did not receive timely referral to a nephrologist.Recent economic models suggest that population-wide screening for CKD may be cost-effective in some settings and scenarios, depending on the population, screening strategy and frequency, treatment assumptions and willingness-to-pay thresholds and may improve kidney and cardiovascular outcomes.For patients to reap the full benefits of newer, more effective treatments for CKD, substantial improvements are needed in albuminuria testing, clinical diagnosis, disease monitoring and referral to nephrologists. Although documented CKD diagnosis and nephrology referral have been associated with more favourable clinical and economic outcomes in observational studies, the proportion with a documented CKD diagnosis was generally low, and many patients did not receive timely referral to a nephrologist. Recent economic models suggest that population-wide screening for CKD may be cost-effective in some settings and scenarios, depending on the population, screening strategy and frequency, treatment assumptions and willingness-to-pay thresholds and may improve kidney and cardiovascular outcomes. For patients to reap the full benefits of newer, more effective treatments for CKD, substantial improvements are needed in albuminuria testing, clinical diagnosis, disease monitoring and referral to nephrologists.