INTRODUCTION: Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. METHODS: Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. RESULTS: We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3-5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. CONCLUSION: Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.

Arbor Research Collaborative for Health Ann Arbor Michigan USA

Centre for Heart Rhythm Disorders The University of Adelaide Adelaide South Australia Australia

Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Department of Internal Medicine Edward Francis Small Teaching Hospital Banjul The Gambia

Department of Internal Medicine University of Uyo Uyo Nigeria

Department of Medicine Division of Nephrology Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico

Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana

Department of Medicine Nazarbayev University School of Medicine Nur Sultan Kazakhstan

Department of Medicine University of Alberta Edmonton Alberta Canada

Department of Medicine University of Calabar Calabar Nigeria

Department of Nephrology 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic

Division of Chronic Kidney Disease Pathophysiology The University of Tokyo Graduate School of Medicine Tokyo Japan

Division of Nephrology and Hypertension University of Cape Town Cape Town South Africa

Division of Nephrology Department of Medicine University of British Columbia Vancouver British Columbia Canada

George Institute for Global Health University of New South Wales New Delhi India

International Society of Nephrology Brussels Belgium

John W Scott Health Sciences Library University of Alberta Edmonton Alberta Canada

Kidney and Hypertension Research Unit University of Cape Town Cape Town South Africa

Population Health Sciences Bristol Medical School University of Bristol Bristol UK

Prasanna School of Public Health Manipal Academy of Higher Education Manipal India

Renal Unit Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana

School of Health Science and Life Nursing School Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre Brazil

School of Medicine Pontificia Universidade Catolica do Parana Curitiba Brazil

School of Public Health Imperial College London UK

Zobrazit více v PubMed

GBD Chronic Kidney Disease Collaboration Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709–733. doi: 10.1016/S0140-6736(20)30045-3. PubMed DOI PMC

Bello A.K., Levin A., Lunney M., et al. Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey. BMJ. 2019;367:l5873. doi: 10.1136/bmj.l5873. PubMed DOI

Sharma S.K., Ghimire A., Carminati S., Remuzzi G., Perico N. Management of chronic kidney disease and its risk factors in eastern Nepal. Lancet Glob Health. 2014;2:e506–e507. doi: 10.1016/S2214-109X(14)70281-5. PubMed DOI

Coresh J., Astor B.C., Greene T., Eknoyan G., Levey A.S. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12. doi: 10.1053/ajkd.2003.50007. PubMed DOI

Gansevoort R.T., Verhave J.C., Hillege H.L., et al. The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney Int Suppl. 2005;(94):S28–S35. doi: 10.1111/j.1523-1755.2005.09408.x. PubMed DOI

Komenda P., Lavallee B., Ferguson T.W., et al. The prevalence of CKD in rural Canadian indigenous peoples: results from the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) screen, triage, and treat program. Am J Kidney Dis. 2016;68:582–590. doi: 10.1053/j.ajkd.2016.04.014. PubMed DOI

Takahashi S., Okada K., Yanai M. The Kidney Early Evaluation Program (KEEP) of Japan: results from the initial screening period. Kidney Int Suppl. 2010;116:S17–S23. doi: 10.1038/ki.2009.539. PubMed DOI

Berns J.S. Routine screening for CKD should be done in asymptomatic adults selectively. Clin J Am Soc Nephrol CJASN. 2014;9:1988–1992. doi: 10.2215/CJN.02250314. PubMed DOI PMC

Qaseem A., Wilt T.J., Cooke M., Denberg T.D. The paucity of evidence supporting screening for stages 1–3 CKD in asymptomatic patients with or without risk factors. Clin J Am Soc Nephrol. 2014;9:1993–1995. doi: 10.2215/CJN.02940314. PubMed DOI PMC

Shlipak M.G., Tummalapalli S.L., Boulware L.E., et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99:34–47. doi: 10.1016/j.kint.2020.10.012. PubMed DOI

World Health Organization Screening and early detection World Health Organization. Updated 2021. https://www.euro.who.int/en/health-topics/noncommunicable-diseases/cancer/policy/screening-and-early-detection

Okpechi I.G., Bello A.K., Luyckx V.A., Wearne N., Swanepoel C.R., Jha V. Building optimal and sustainable kidney care in low resource settings: the role of healthcare systems. Nephrology (Carlton, Vic) 2021;26:948–960. doi: 10.1111/nep.13935. PubMed DOI

Vanholder R., Davenport A., Hannedouche T., et al. Reimbursement of dialysis: a comparison of seven countries. J Am Soc Nephrol. 2012;23:1291–1298. doi: 10.1681/ASN.2011111094. PubMed DOI

Tonelli M., Dickinson J.A. Early detection of CKD: implications for low-income, middle-income, and high-income countries. J Am Soc Nephrol. 2020;31:1931–1940. doi: 10.1681/ASN.2020030277. PubMed DOI PMC

George C., Mogueo A., Okpechi I., Echouffo-Tcheugui J.B., Kengne A.P. Chronic kidney disease in low-income to middle-income countries: the case for increased screening. BMJ Glob Health. 2017;2 doi: 10.1136/bmjgh-2016-000256. PubMed DOI PMC

de Jong P.E., van der Velde M., Gansevoort R.T., Zoccali C. Screening for chronic kidney disease: where does Europe go? Clin J Am Soc Nephrol. 2008;3:616–623. doi: 10.2215/CJN.04381007. PubMed DOI PMC

Jaar B.G., Khatib R., Plantinga L., Boulware L.E., Powe N.R. Principles of screening for chronic kidney disease. Clin J Am Soc Nephrol. 2008;3:601–609. doi: 10.2215/CJN.02540607. PubMed DOI PMC

Boulware L.E., Jaar B.G., Tarver-Carr M.E., Brancati F.L., Powe N.R. Screening for proteinuria in US adults: a cost-effectiveness analysis. JAMA. 2003;290:3101–3114. doi: 10.1001/jama.290.23.3101. PubMed DOI

Mani M.K. Experience with a program for prevention of chronic renal failure in India. Kidney Int Suppl. 2005;(94):S75–S78. doi: 10.1111/j.1523-1755.2005.09419.x. PubMed DOI

Sumaili E.K., Nseka N.M., Lepira F.B., et al. Screening for proteinuria and chronic kidney disease risk factors in Kinshasa: a world kidney day 2007 study. Nephron Clin Pract. 2008;110:c220–c228. doi: 10.1159/000167869. PubMed DOI

American Society of Nephrology ASN emphasizes need for early detection of kidney disease, a silent killer. American Society of Nephrology. https://www.asn-online.org/news/2013/ASN_COMM_ACP_Screening_Response_102213_R12.pdf Published 2013.

Garcia-Garcia G., Jha V., Tao Li P.K.T., et al. Chronic kidney disease (CKD) in disadvantaged populations. Clin Kidney J. 2015;8:3–6. doi: 10.1093/ckj/sfu124. PubMed DOI PMC

Tricco A.C., Lillie E., Zarin W., et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–473. doi: 10.7326/M18-0850. PubMed DOI

Peters M.D., Marnie C., Tricco A.C., et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18:2119–2126. doi: 10.11124/JBIES-20-00167. PubMed DOI

Okpechi I.G., Caskey F.J., Gaipov A., et al. Assessing the impact of screening, early identification and intervention programmes for chronic kidney disease: protocol for a scoping review. BMJ Open. 2021;11 doi: 10.1136/bmjopen-2021-053857. PubMed DOI PMC

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, Suppl. 2012;3:136–150.

Levac D., Colquhoun H., O’Brien K.K. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. doi: 10.1186/1748-5908-5-69. PubMed DOI PMC

Qaseem A., Hopkins R.H., Jr., Sweet D.E., Starkey M., Shekelle P. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159:835–847. doi: 10.7326/0003-4819-159-12-201312170-00726. PubMed DOI

National Kidney Foundation (NKF) Kidney disease screening is valuable for those at risk. National Kidney Foundation (NKF). Published 2012. https://www.kidney.org/news/newsroom/nr/kidneydiseasescreeningisvaluable

Gray J.A., Patnick J., Blanks R.G. Maximising benefit and minimising harm of screening. BMJ. 2008;336:480–483. doi: 10.1136/bmj.39470.643218.94. PubMed DOI PMC

Wilson J.M.G., Jungner G., World Health Organization Principles and Practice of Screening for Disease. World Health Organization. https://apps.who.int/iris/handle/10665/37650 Published 1968.

Dobrow M.J., Hagens V., Chafe R., Sullivan T., Rabeneck L. Consolidated principles for screening based on a systematic review and consensus process. CMAJ. 2018;190 doi: 10.1503/cmaj.171154. E422-e9. PubMed DOI PMC

Gutierrez-Padilla J.A., Mendoza-Garcia M., Plascencia-Perez S., et al. Screening for CKD and cardiovascular disease risk factors using mobile clinics in Jalisco, Mexico. Am J Kidney Dis. 2010;55:474–484. doi: 10.1053/j.ajkd.2009.07.023. PubMed DOI

Tonelli M., Tiv S., Anand S., et al. Diagnostic yield of population-based screening for chronic kidney disease in low-income, middle-income, and high-income countries. JAMA Netw Open. 2021;4 doi: 10.1001/jamanetworkopen.2021.27396. PubMed DOI PMC

Hallan S.I., Dahl K., Oien C.M., et al. Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ. 2006;333:1047. doi: 10.1136/bmj.39001.657755.BE. PubMed DOI PMC

Craig J.C., Barratt A., Cumming R., Irwig L., Salkeld G. Feasibility study of the early detection and treatment of renal disease by mass screening. Int Med J. 2002;32:6–14. PubMed

Howard K., White S., Salkeld G., et al. Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: a modeled analysis. Value Health. 2010;13:196–208. doi: 10.1111/j.1524-4733.2009.00668.x. PubMed DOI

Manns B., Hemmelgarn B., Tonelli M., et al. Population based screening for chronic kidney disease: cost effectiveness study. BMJ. 2010;341:c5869. doi: 10.1136/bmj.c5869. PubMed DOI PMC

Xie Y., Bowe B., Mokdad A.H., et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018;94:567–581. doi: 10.1016/j.kint.2018.04.011. PubMed DOI

Johnson R.J., Wesseling C., Newman L.S. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med. 2019;380:1843–1852. doi: 10.1056/NEJMra1813869. PubMed DOI

Lebov J.F., Valladares E., Peña R., et al. A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis. 2015;2:6. doi: 10.1186/s40697-015-0041-1. PubMed DOI PMC

Jha V., Modi G.K. eGFR testing around the world: justice, access, and accuracy. Clin J Am Soc Nephrol. 2021;16:963–965. doi: 10.2215/CJN.16001020. PubMed DOI PMC

Lamb E.J., MacKenzie F., Stevens P.E. How should proteinuria be detected and measured? Ann Clin Biochem. 2009;46:205–217. doi: 10.1258/acb.2009.009007. PubMed DOI

Norton J.M., Ali K., Jurkovitz C.T., et al. Development and validation of a pragmatic electronic phenotype for CKD. Clin J Am Soc Nephrol. 2019;14:1306–1314. doi: 10.2215/CJN.00360119. PubMed DOI PMC

Delgado C., Baweja M., Crews D.C., et al. A unifying approach for GFR estimation: recommendations of the NKF-ASN Task Force on Reassessing the inclusion of race in diagnosing kidney disease. J Am Soc Nephrol. 2022;79:268–288.e1. doi: 10.1681/ASN.2021070988. PubMed DOI

Htay H., Alrukhaimi M., Ashuntantang G.E., et al. Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project. Kidney Int Suppl. 2018;8:64–73. doi: 10.1016/j.kisu.2017.10.010. PubMed DOI PMC

Kent D.M., Jafar T.H., Hayward R.A., et al. Progression risk, urinary protein excretion, and treatment effects of angiotensin-converting enzyme inhibitors in nondiabetic kidney disease. J Am Soc Nephrol. 2007;18:1959–1965. doi: 10.1681/ASN.2006101081. PubMed DOI

Wright J.T., Jr., Bakris G., Greene T., et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421–2431. doi: 10.1001/jama.288.19.2421. PubMed DOI

Wang K., Hu J., Luo T., et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality and renal outcomes in patients with diabetes and albuminuria: a systematic review and meta-analysis. Kidney Blood Press Res. 2018;43:768–779. doi: 10.1159/000489913. PubMed DOI

Jafar T.H., Schmid C.H., Landa M., et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;135:73–87. doi: 10.7326/0003-4819-135-2-200107170-00007. PubMed DOI

Palmer S.C., Tendal B., Mustafa R.A., et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2021;372:m4573. doi: 10.1136/bmj.m4573. PubMed DOI PMC

Bakris G.L., Agarwal R., Anker S.D., et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383:2219–2229. doi: 10.1056/NEJMoa2025845. PubMed DOI

Wheeler D.C., Stefánsson B.V., Jongs N., et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol. 2021;9:22–31. doi: 10.1016/S2213-8587(20)30369-7. PubMed DOI

Wong L.L., Kalantar-Zadeh K., Page V., Hayashida G., You A.S., Rhee C.M. Insights from screening a racially and ethnically diverse population for chronic kidney disease. Am J Nephrol. 2017;45:200–208. doi: 10.1159/000455389. PubMed DOI PMC