Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review

Background Targeted screening interventions for chronic kidney disease (CKD) are increasingly being implemented in various community settings. However, the overall success of these programs is uncertain. Therefore, the aim of this review is to determine whether targeted screening is effective in detecting people with undiagnosed CKD.

Methods We performed a systematic literature review, and included studies of targeted screening intervention implemented in any community-based setting. Studies were required to have targeted people aged ≥18 years, and multiple CKD risk factors from the following: diabetes, hypertension, cardiovascular disease and family history of kidney disease. The outcome measures were percentages of participants with positive screening test results and diagnosed with CKD at follow-up.

Results Nine studies met the inclusion criteria. Eight studies reported the percentage of participants with positive screening test results, which ranged from 7 to 60.3%. Only two studies repeated the diagnostic tests to detect CKD, and confirmed the chronicity of CKD in 20.5 and 17.1% of screened participants. The most commonly used screening tests were albumin creatinine ratio (≥3.4 mg/mmol), and estimated glomerular filtration rate (eGFR) (<60 ml/ min/1.73 m²). All studies classified CKD stage 3 and above based on eGFR alone. Characteristics of the interventions responsible for inconsistencies in the outcome measures included CKD risk factors targeted, and screening tests used to detect CKD.

Conclusions This systematic review found significant variation in the methods that were used to detect CKD, with the majority of studies reporting results based on only single albuminuria or eGFR values. Future targeted screening programs should appropriately use the 2012 KDIGO guidelines in order to detect CKD, which is necessary to determine the benefit of these programs when implemented in community-settings.