Evidence Lacking for Value of CKD Screening and Monitoring
(HealthDay News) – There is no evidence that screening and monitoring for chronic kidney disease (CKD) improves clinical outcomes.
In an effort to provide an evidence base to guide recommendations coming from the US Preventive Services Task Force and the American College of Physicians, Howard A. Fink, MD, MPH, of the Minneapolis Veterans Affairs Medical Center, and colleagues reviewed randomized, controlled trials that evaluated screening, monitoring, or treatment of CKD; reported clinical outcomes; and discussed the benefits and harms of screening and monitoring.
The researchers found that 110 trials assessed treatments, and no trials evaluated screening or monitoring. Compared with placebo, angiotensin-converting enzyme inhibitors and angiotensin II-receptor blockers decreased end-stage renal disease (relative risk [RR], 0.65 and 0.77, respectively), mainly in patients with diabetes who had macroalbuminuria. For patients with microalbuminuria and cardiovascular disease or high-risk diabetes, angiotensin-converting enzyme inhibitors reduced mortality compared to placebo (RR, 0.79). For patients with impaired estimated glomerular filtration rate and either hyperlipidemia or congestive heart failure, statins and β-blockers reduced mortality and cardiovascular events, compared to placebo or control. There was no difference in mortality, end-stage renal disease, or other clinical outcomes with strict or usual blood pressure control. For angiotensin II-receptor blockers and statins, the evidence was rated high; for angiotensin-converting enzyme inhibitors and β-blockers, moderate; and for strict blood pressure control, low.
"We need more research to develop outcome measures that will comprehensively capture the effect of CKD treatments on the diverse and disparate outcomes encountered in this complex population," write the authors of an accompanying editorial.