Targeted screening of individuals with hypertension, diabetes, or age >55 identified 93.2% of chronic kidney disease cases with a number needed to screen of 8.7.
Cohort (n=65,604)
What is the most effective screening strategy for detecting chronic kidney disease in the general adult population?
Targeted screening for chronic kidney disease in individuals with hypertension, diabetes, or age >55 is highly effective for detection, though the subsequent risk of progression to end-stage renal disease is low compared to the high risk of cardiovascular mortality.
OBJECTIVE: To find an effective screening strategy for detecting patients with chronic kidney disease and to describe the natural course of the disease. DESIGN: Eight year follow-up of a cross sectional health survey (the HUNT II study). SETTING: Nord-Trøndelag County, Norway PARTICIPANTS: 65,604 people (70.6 % of all adults aged >or=20 in the county). MAIN OUTCOME MEASURES: Incident end stage renal disease (ESRD) and cardiovascular mortality monitored by individual linkage to central registries. RESULTS: 3069/65,604 (4.7%) people had chronic kidney disease (estimated glomerular filtration rate 55 would identify 93.2% (92.4% to 94.0%) of patients with chronic kidney disease, with a number needed to screen of 8.7 (8.5 to 9.0). Restriction of screening according to guidelines of the United States kidney disease outcomes quality initiative (US KDOQI) gave similar results, but restriction according to the United Kingdom's chronic kidney disease guidelines detected only 60.9% (59.1% to 62.8%) of cases. Screening only people with previously known diabetes or hypertension detected 44.2% (42.7% to 45.7%) of all cases, with a number needed to screen of six. During the eight year follow-up only 38 of the 3069 people with chronic kidney disease progressed to end stage renal disease, and the risk was especially low in people without diabetes or hypertension, women, and those aged >or=70 or with a glomerular filtration rate 45-59 ml/min/1.73 m(2) at screening. In contrast, there was a high cardiovascular mortality: 3.5, 7.4, and 10.1 deaths per 100 person years among people with a glomerular filtration rate 45-59, 30-44, and 55 was the most effective strategy to detect patients with chronic kidney disease, but the risk of end stage renal disease among those detected was low.
Hallan et al. (Tue,) conducted a cohort in chronic kidney disease (n=65,604). Targeted screening (hypertension, diabetes, or age >55) vs. Universal screening was evaluated on Incident end stage renal disease (ESRD) and cardiovascular mortality. Targeted screening of individuals with hypertension, diabetes, or age >55 identified 93.2% of chronic kidney disease cases with a number needed to screen of 8.7.