Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review

Abstract

Rationale & Objective

Kidney failure can be prevented or delayed if chronic kidney disease (CKD) is detected and treated early. Targeted screening has been shown effective in detecting CKD worldwide, but a recently updated summary of evidence is lacking. We synthesized up-to-date evidence of the effectiveness of risk factor-based screening for the early detection of CKD among adults in primary care.

Study Design

We retrieved articles from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus. Relevant gray literature and hand-searching bibliographies of key articles were also performed.

Setting & Study Populations

Adult patients (age ≥ 18 years) with at least 1 known CKD risk factor in primary care.

Selection Criteria for Studies

Prospective studies applying CKD screening in adults based on at least 1 CKD risk factor.

Data Extraction

Data were abstracted from full texts and the risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools.

Analytical Approach

No meta-analysis was conducted.

Results

In total, 24 studies from 11 countries fulfilled the inclusion criteria. Diverse screening tests, CKD definitions, formulas for estimating kidney function, and positive screening test cutoffs were used. Most studies (n = 22) employed estimated glomerular filtration rate (eGFR), albumin-creatinine ratio (ACR) (n = 14), and dipstick urinalysis (n = 9) for screening. The prevalence of reduced kidney function and/or kidney damage was between 2.9% and 56%, and confirmed CKD varied from 4.4% to 17.1%. Increased patient referrals and physician visits, higher patient satisfaction, and some form of patient willingness to pay for the services were reported because of screening.

Limitations

Meta-analysis was not conducted, and the findings might not be generalized to resource-limited settings.

Conclusions

Risk factor-based screening effectively identifies a substantial proportion of people with undiagnosed CKD, but there is still scope for improvement. We recommend future studies have robust designs and multidimensional interventions to establish the effectiveness of targeted CKD screening in primary care.

Plain Language Summary

Chronic kidney disease (CKD) is a major public health issue worldwide. Targeted screening programs for high-risk populations (eg, diabetes) are clinically effective and cost-effective in detecting CKD, according to studies. We conducted a systematic review to summarize up-to-date evidence on risk factor-based screening for early detection of CKD in primary care. From the results, it may be inferred that targeted screening effectively detects a significant proportion of previously unknown CKD in primary care. However, there are inconsistencies in study design, screening tests, and measurement across studies. This study highlights the integral role of CKD screening in primary care settings including community pharmacies and the need for robustly designed studies (eg, cluster randomized controlled trials) to establish the effectiveness of targeted CKD screening in primary care.