Some Frequently Ordered Tests May Not Be Necessary to Diagnose CKD
Many of the tests performed to screen for chronic kidney disease (CKD) may offer little clinical benefit on diagnosis and management, according to a research letter. Findings from the study are published in JAMA Internal Medicine.
Researchers from the Brigham and Women's Hospital in Boston conducted a retrospective cohort study (n=1487) of patients referred for initial CKD evaluation from 2010–2013. They reviewed nephrology progress notes to analyze the presumed cause of CKD, and if the tests directly contributed to, confirmed, or established the diagnosis and management of CKD.
The tests often measured levels of calcium, hemoglobin, phosphate, urine sediment, and parathyroid hormone among others. Analyses showed that serum protein electrophoresis and screening for antinuclear antibody, C3, C4, hepatitis C, hepatitis B, and antineutrophil cytoplasmic antibody were performed up to 68% of the time although these tests do not usually help with CKD diagnosis or management. Among all the tests obtained, hemoglobin A1c and urine protein quantification had the highest rates of impact on diagnosis and management.
Study authors suggest that an evidence-based, targeted approach based on pretest probabilities of disease may improve efficiency in diagnosis and management rather than a default order of various tests for CKD. Future steps will include clinical recommendations on which tests to include and avoid in CKD evaluation.
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