The USPSTF draft recommendations are sobering reading. Why so?
Here are 5 statements from the USPSTF report:
- There is inadequate evidence that routine screening for CKD improves clinical outcomes for asymptomatic adults.
- There is inadequate evidence on the harms of screening for CKD. However, there is convincing evidence that medications used to treat early CKD may have side effects.
- There is no generally accepted risk assessment tool for CKD or risk for complications of CKD. Diabetes and hypertension are well established risk factors with a strong link to CKD. Other risk factors for CKD include older age, cardiovascular disease, obesity, and family history.
- While there is insufficient evidence to recommend routine screening, the tests often suggested for screening that are feasible in primary care include testing the urine for protein (microalbuminuria or macroalbuminuria) and testing the blood for serum creatinine to estimate GFR. No studies have evaluated the sensitivity and specificity of one-time testing with either or both tests for diagnosis of CKD, defined as decreased kidney function or kidney damage persisting for at least 3 months.
- Treatment for early stages of CKD is generally targeted to comorbid conditions, such as diabetes, hypertension, and cardiovascular disease, to reduce the risk for complications and progression of CKD. These treatments include blood pressure medications (particularly angiotensin-converting enzyme inhibitors and angiotensin II–receptor blockers), lipid-lowering agents, and diet.
The statements speak for themselves. CKD affects 1 in every 10 people in the United States – and some groups like blacks and latinos the prevalence is much higher. Yet, we lack the answers to fundamental questions.
Quoting from an ASN press release in the context of the ASN [Capitol] Hill day:
ASN leaders urged Congress to do the following:
- Pass pending legislation for lifetime coverage of anti-rejection drugs for transplant recipients, saving lives and dollars (HR2969);
- Support and promote the programs necessary to eliminate disparities in kidney care. Groups most affected by these disparities include African Americans, Hispanics and Native Americans;
- Provide NIH the necessary funds to enable researchers to continue to make gains in addressing the growing threat kidney disease poses to public health.
The bottom-line is that there needs to be more research on some fundamental issues in kidney disease. Either the government needs to spend more or the NIH has to re-direct money spent on other priorities. Clearly something has to give.
