Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health surveyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39001.657755.BE (Published 16 November 2006) Cite this as: BMJ 2006;333:1047
- Stein I Hallan, associate professor1,
- Ketil Dahl, consultant2,
- Cecilia M Oien, consultant2,
- Diana C Grootendorst, postdoctoral fellow3,
- Arne Aasberg, consultant4,
- Jostein Holmen, professor5,
- Friedo W Dekker, associate professor3
- 1Department of Cancer Research and Molecular Biology, Faculty of Medicine, Norwegian University of Science and Technology, 7006 Trondheim, Norway
- 2Department of Medicine, Division of Nephrology, St Olav University Hospital, 7006 Trondheim, Norway
- 3Department of Clinical Epidemiology, Leiden University Medical Center, 2300 Leiden, Netherlands
- 4Department of Clinical Biochemistry, St Olav University Hospital, 7006 Trondheim, Norway
- 5HUNT Research Center, Faculty of Medicine, Norwegian University of Science and Technology, 7650 Verdal, Norway
- Correspondence to: S I Hallan
- Accepted 14 September 2006
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.
This is version 3 of the paper. Due to an error in the analysis the figures given for the UK chronic kidney disease guidelines in the abstract, results section, and table 3 were incorrect. These have been amended. The changes do not have any effect on the conclusions of the paper.
The HUNT study is a collaboration between HUNT Research Center, Faculty of Medicine, Norwegian University of Science and Technology, Verdal; Norwegian Institute of Public Health, Oslo; Nord-Trondelag County Council; and Central Norway Regional Health Authority. We thank the health service and people of Nord-Trondelag for their endurance and participation and Stephen Lock for his help in preparing the manuscript.
Contributors: SIH (guarantor), JH, and KD were responsible for conception and design. SIH, FWD, DCG, AA, and CMO analysed and interpreted the data. SIH drafted the article and FWD, DCG, KD, CMO, AA, and JH revised it. JH was in charge of the data collection during the HUNT study.
Funding: KD and AA are employed at St Olav's Hospital. SIH, CMO, and JH are funded by Norwegian University of Science and Technology. FWD and DCG are funded by Leiden University.
Competing interests: None declared.
Ethical approval: Regional committee for medical research ethics, health region 4, Norway. Additional permission for linking data registries and for handling the health data was given by the Health Department and by the Data Inspectorate, respectively.