Diagnostic Yield of Population-Based Screening for Chronic Kidney Disease in Low-Income, Middle-Income, and High-Income Countries
Authors: Marcello Tonelli, Sophanny Tiv, Shuchi Anand, Deepa Mohan, Guillermo Garcia Garcia, José Alfonso Gutiérrez Padilla, Scott Klarenbach, Guillermo Navarro Blackaller, Sidy Seck, Jinwei Wang, Luxia Zhang, Paul Muntner
Journal: JAMA Network Open (2021)

IMPORTANCE Population-based screening for chronic kidney disease (CKD) is sometimes recommended based on the assumption that detecting CKD is associated with beneficial changes in treatment.However, the treatment of CKD is often similar to the treatment of hypertension or diabetes, which commonly coexist with CKD.OBJECTIVE To determine the frequency with which population-based screening for CKD is associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia. DESIGN, SETTING, AND PARTICIPANTSThis cohort study was conducted using data obtained from studies that evaluated CKD in population-based samples from China (2007-2010), India (2010-2014), Mexico (2007-2008), Senegal (2012), and the United States (2009-2014), including a total of 126 242 adults screened for CKD.Data were analyzed from January 2020 to March 2021. MAIN OUTCOMES AND MEASURESThe primary definition of CKD was estimated glomerular filtration rate less than 60 mL/min/1.73m 2 .For individuals with CKD, the need for a treatment change was defined as not taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker or having blood pressure levels of 140/90 mm Hg or greater.For individuals with CKD who also had diabetes, the need for a treatment change was also defined as having hemoglobin A 1c levels of 8% or greater or fasting glucose levels of 178.4 mg/dL (9.9 mmol/L) or greater.Case finding was defined as testing for CKD only in adults with hypertension or diabetes.RESULTS Among 126 242 adults screened for CKD, there were 47 204 patients in the China cohort, 9817 patients in the India cohort, 51 137 patients in the Mexico cohort, 2441 patients in the Senegal cohort, and 15 643 patients in the US cohort.The mean age of participants was 49.6 years (95% CI, 49.5-49.7 years) in the China cohort, 42.9 years (95% CI, 42.6-43.2years) in the India cohort, 51.6 years (95% CI, 51.5-51.7 years) in the Mexico cohort, 48.2 years (95% CI, 47.5-48.9years) in the Senegal cohort, and 47.3 years (95% CI, 46.6-48.0years) in the US cohort.The proportion of women was 57.3% (95% CI, 56.9%-57.7%) in the China cohort, 53.4% (95% CI, 52.4%-54.4%) in the India cohort, 68.8% (95% CI, 68.4%-69.2%) in the Mexico cohort, 56.0% (95% CI, 54.0%-58.0%) in the Senegal cohort, and 51.9% (51.0%-52.7%) in the US cohort.The prevalence of CKD was 2.5% (95% CI, 2.4%-2.7%) in the China cohort, 2.3% (95% CI, 2.0%-2.6%) in the India cohort, 10.6% (95% CI, 10.3%-10.9%) in the Mexico cohort, 13.1% (95% CI, 11.7%-14.4%) in the Senegal cohort, and 6.8% (95% CI, 6.2%-7.5%) in the US cohort.Screening for CKD was associated with the identification of additional adults whose treatment would change (beyond those identified by measuring blood pressure and glycemia) per 1000 adults: China: 8 adults (95% CI, 8-9 adults); India: 5 adults (95% CI, 4-7 adults); Mexico: 26 adults (95% CI, 24-27 adults); Senegal: 59 adults (95% CI, 50-69 adults); and the US: 19 adults (95% CI, 16-23 adults).Case finding was associated with the identification of 46.2% (continued) Key Points Question How frequently is population-based screening for chronic kidney disease (CKD) associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia?Findings This epidemiologic assessment of 126 242 adults screened for CKD in population-based cohorts from China, India, Mexico, Senegal, and the United States found that most treatment gaps identified by population-based screening for CKD were apparent by measuring blood pressure or glycemic control.Case finding, defined by testing for CKD only in adults with hypertension or diabetes, was associated with a lower frequency of testing and a greater proportion of individuals with identified treatment gaps compared with screening.Meaning These findings suggest that case finding was more efficient than population-based screening and detected most patients with CKD requiring treatment changes.