BMJ  2006;333:1047 (18 November), doi:10.1136/bmj.39001.657755.BE (published 24 October 2006)

Research

Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey

¹ Department of Cancer Research and Molecular Biology, Faculty of Medicine, Norwegian University of Science and Technology, 7006 Trondheim, Norway, ² Department of Medicine, Division of Nephrology, St Olav University Hospital, 7006 Trondheim, Norway, ³ Department of Clinical Epidemiology, Leiden University Medical Center, 2300 Leiden, Netherlands, ⁴ Department of Clinical Biochemistry, St Olav University Hospital, 7006 Trondheim, Norway, ⁵ HUNT Research Center, Faculty of Medicine, Norwegian University of Science and Technology, 7650 Verdal, Norway

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 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 <60 ml/min/1.73 m²), so we would need to screen 20.6 people (95% confidence interval 20.0 to 21.2) to identify one case. Restriction of screening to those with hypertension, diabetes, or age >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 70 or with a glomerular filtration rate 45-59 ml/min/1.73 m² 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 <30 ml/min/1.73 m², respectively.

Conclusion Screening people with hypertension, diabetes mellitus, or age >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.

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Rapid Responses:

Read all Rapid Responses

Effective Screening strategy ought to be adaptable to the type of community

Emeka Anthony Nwankwo
bmj.com, 7 Nov 2006 [Full text]

Who put CKD in the new GP contract?

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