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Screening for Chronic Kidney Disease: Unresolved Issues

William M. McClellan^*,, Sylvia P. B. Ramirez and Claudine Jurkovitz

*Georgia Medical Care Foundation, Atlanta; Department of Epidemiology, Rollins School of Public Health, and Emory Center for Outcomes Research, School of Medicine, Emory University, Atlanta, Georgia; and National Kidney Foundation Singapore, Singapore.

Correspondence to Dr. William McClellan, Georgia Medical Care Foundation, 57 Executive Park South, NE, Suite 200, Atlanta, GA. Phone: 404-982-7573; Fax: 678-527-3473;

ABSTRACT. End-stage renal disease is epidemic in the United States. As a measure to control this epidemic, it has been recommended that individuals who are at risk for CKD be tested for undetected kidney disease during routine health care encounters. There are generally accepted criteria against which screening recommendations for CKD control and prevention programs should be judged. If detection strategies are to be adopted for the screening of kidney disease, then CKD must represent a significant public health problem, be characterized by a clear natural history with a detectable asymptomatic period, outcomes should be improved by early treatment, and acceptable screening tests should be available. Health systems must provide adequate and appropriate follow-up medical care for individuals with newly detected CKD. Finally, the cost-effectiveness of screening needs to be demonstrated and the effectiveness of screening as a means of achieving reductions in CKD should be proven in randomized trials. E-mail bmcclellan@gmcf.org

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673