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New York, NY (November 1, 2013) – The National Kidney Foundation (NKF) and the Renal Physicians Association (RPA) recommend that healthcare professionals test patients in specific high risk groups for chronic kidney disease (CKD) – particularly those with diabetes or high blood pressure--as a cost effective strategy for delaying disease progression and reducing complications.
A new guideline issued last week by the American College of Physicians (ACP) discourages routine testing for kidney disease in asymptomatic individuals with no risk factors. The National Kidney Foundation and the Renal Physicians Association are in agreement with the ACP that screening is not necessary for the general population without risk conditions.
"There is little or no evidence to suggest that screening people without symptoms or risk factors is beneficial. In addition, mass screening will increase false positive test results, which in turn will lead to unnecessary concerns, additional tests, and excess costs. However, screening risk groups is recommended by the NKF and RPA, particularly those with diabetes and/or hypertension. Screening for CKD in these risk groups was shown to be cost effective in a recent analysis," said Joseph Vassalotti, MD, National Kidney Foundation's Chief Medical Officer.
"In addition, NKF and RPA recommend screening for other risk groups to promote early detection and management, including African Americans and at- risk ethnic groups, those age 60 and older and those with family history of kidney failure. CKD detection drives patient awareness and changes management -- that is why testing is so important. Control of hypertension can slow progression or loss of kidney function over time, delaying the onset of kidney failure. Management of CKD also includes a patient safety approach to drug prescription practices for certain medications cleared by the kidneys. Avoiding certain medications and judicious use of iodinated contrast media for imaging can prevent acute kidney injury in those at risk with CKD. Lastly, timely nephrology referral and preparation for dialysis and kidney transplantation are dependent on primary care detection," continued Vassalotti.
According to RPA President Robert Kossmann, MD, "Screening those at risk is cost-effective because it can help delay progression of kidney disease for some and properly prepare those who do progress to kidney failure for dialysis and or transplant, resulting in fewer hospitalizations and medical interventions. However, screening those not at risk is unnecessary. Coincident with recent years' CKD screening efforts, the 2013 USRDS has shown a decrease in the number of incident dialysis patients. Our hope is that this represents identification of CKD patients at a point in their disease process that has allowed interventions to prevent or delay ESRD. In a time of escalating healthcare costs, we need to focus on interventions that improve outcomes and make a real difference in people's lives."
The ACP's new guideline also advises against testing for high levels of protein in the urine in people with or without diabetes who are taking certain blood pressure drugs, such as an ACE inhibitor or an ARB.
The National Kidney Foundation and Renal Physicians Association differ from the ACP on the above recommendation. NKF and RPA recommend monitoring of proteinuria, or protein in the urine (one of the very earliest signs of kidney damage) at least annually in those with major risk factors such as diabetes, even if they are taking a blood pressure drug.
"If proteinuria increases that could be a reason to intensify therapy with one of the kidney- protective blood pressure drugs, ACE inhibitors or ARBs. In addition, if a person has hypertension, severely increased proteinuria may be a reason to consider referral to a kidney specialist for a biopsy to look for a cause of kidney disease other than high blood pressure," said Vassalotti.
The National Kidney Foundation (NKF) is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families and tens of millions of Americans at risk. For more information visit www.kidney.org.
The Renal Physicians Association (RPA) is the professional organization of nephrologists whose goals are to ensure optimal care under the highest standards of medical practice for patients with renal disease and related disorders. RPA acts as the national representative for physicians engaged in the study and management of patients with renal disease. More information about the RPA, its positions and its programs is available at www.renalmd.org.