Screening cannot be recommended on the basis of current knowledge

Low glomerular filtration rate predicts cardiovascular disease, end stage renal disease (a requirement for dialysis or transplantation), and death.1 In a population based study reported in this week's issue, Hallan and colleagues describe the yield of different screening strategies aimed at identifying people with low glomerular filtration rates.1 The guidelines of the United States kidney disease outcomes quality initiative define chronic kidney disease as glomerular filtration rate persistently lower than 60 ml/min/1.73m², persistent urine abnormalities, or clinically relevant anatomical abnormalities, and they recommend measuring serum creatinine to determine estimated glomerular filtration rate in high risk groups.2 The Kidney Disease Improving Global Outcomes Group (an international organisation that seeks to improve care and outcomes for people with kidney disease) and draft UK guidelines endorse the classification but do not, at present, look at screening.3 4

All screening programmes cause physical, psychological, and social harm through the screening test itself, and through the investigation and treatment of abnormal results. No trials to show whether the benefits of screening for low glomerular filtration rate outweigh the harms have been conducted. So how …