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Screening for chronic kidney disease in adults without symptoms not recommended

Date:
October 21, 2013
Source:
American College of Physicians
Summary:
New guideline presents evidence-based recommendations for screening, monitoring, and treatment of adults with stage 1-3 chronic kidney disease, and advise against screening for adults without symptoms or risk factors.
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The American College of Physicians (ACP) recommends against screening for chronic kidney disease (CKD) in asymptomatic adults without risk factors. ACP's new clinical practice guideline, "Screening, Monitoring, and Treatment of Stage 1-3 Chronic Kidney Disease," was published today in Annals of Internal Medicine, ACP's flagship journal.

"There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease," said Molly Cooke, MD, FACP, president, ACP. "The potential harms of all the screening tests -- false positives, disease labeling, and unnecessary treatment and associated adverse effects -- outweigh the benefits."

The major risk factors for CKD include diabetes, hypertension, and cardiovascular disease. The current evidence is insufficient to evaluate the benefits and harms of screening in asymptomatic adults with risk factors.

ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB).

For treatment, ACP recommends treating patients with hypertension and stage 1-3 CKD with either an ACE inhibitor or an ARB. ACP recommends a statin therapy to manage elevated low density lipoprotein in patients with stage 1-3 CKD.

Head-to-head trials showed no difference in the outcomes between ACE inhibitors or ARBs. The risk of adverse effects significantly increased with an ACE inhibitor combined with an ARB combination therapy, including cough, hyperkalemia, hypotension, and acute kidney failure requiring dialysis.

ACP's guideline also includes advice to help physicians practice high value care.

"Ordering lab tests is not going to have any impact on clinical outcomes of asymptomatic patients with CKD without risk factors but will add unnecessary costs to the health care system due to increased medical visits and unnecessary tests," Dr. Cooke said.

ACP also found the evidence inconclusive for periodic laboratory monitoring of patients diagnosed with stage 1-3 CKD.


Story Source:

The above post is reprinted from materials provided by American College of Physicians. Note: Materials may be edited for content and length.


Journal Reference:

  1. Amir Qaseem. Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the Clinical Guidelines Committee of the American College of Physicians. Annals of Internal Medicine, 2013; DOI: 10.7326/0003-4819-159-12-201312170-00726

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American College of Physicians. "Screening for chronic kidney disease in adults without symptoms not recommended." ScienceDaily. ScienceDaily, 21 October 2013. <www.sciencedaily.com/releases/2013/10/131021211708.htm>.
American College of Physicians. (2013, October 21). Screening for chronic kidney disease in adults without symptoms not recommended. ScienceDaily. Retrieved August 28, 2015 from www.sciencedaily.com/releases/2013/10/131021211708.htm
American College of Physicians. "Screening for chronic kidney disease in adults without symptoms not recommended." ScienceDaily. www.sciencedaily.com/releases/2013/10/131021211708.htm (accessed August 28, 2015).

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