The ACP guidelines on the heals of the US Preventive Services Task Force guidelines, which came to a similar conclusion.
The ACP's position...Recommendation 1: ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence).
"No randomized, controlled trials evaluated the benefits and harms of screening for stage 1 to 3 CKD. Benefit of screening would be derived from the anticipated benefits of treatment. No studies tested the sensitivity and specificity of 1-time screening in the general population using estimated GFR or albuminuria for diagnosis of CKD. There was no evidence evaluating the benefits of early treatment on clinical outcomes of patients with CKD who were identified through screening. Potential harms of screening include labeling, adverse effects of unnecessary tests and treatments, and financial ramifications.
No randomized, controlled trials evaluated the benefits and harms of monitoring patients with stage 1 to 3 CKD for disease progression. Rates of annual GFR decline are variable, and lower GFR rates have been associated with increased mortality risk. Because there is considerable individual variability in albuminuria measurements, there are concerns about the accuracy of longitudinal measurement for CKD progression. Also, evidence evaluating the validity and reliability of the monitoring tests is lacking. Potential harms of monitoring for CKD progression are the same as those for screening."
The ASN's position..."If detected early in its progression, kidney disease can be slowed and the transition to dialysis delayed," ASN President Bruce A. Molitoris, MD, said in the ASN statement. "This evidence-based fact is why regular screening and early intervention by a nephrologist is so important to stemming the epidemic of kidney disease in the United States and why ASN strongly recommends it."
My view: the ACP is wrong to issue a recommendation based on low quality evidence. The fact that it is a weak recommendation will be lost on insurer's who would pay for the screening.
While the evidence to support the effectiveness of early intervention - in CKD stage 1-3 - in slowing the progression of kidney disease is weak (as noted by the ACP) it is because no studies (especially RCTs) have been done.
In other words, "the absence of evidence is not the evidence of absence".
