What are the evidence-based recommendations regarding screening, monitoring, and treatment of adults with stage 1-3 chronic kidney disease (CKD)?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Evidence-based recommendations from the American College of Physicians (ACP) regarding the screening, monitoring, and treatment of adults with stage 1-3 CKD recommend against CKD screening for asymptomatic adults with no risk factors for kidney disease. The ACP’s position, however, has been disputed by the American Society of Nephrology (ASN). [43, 44, 45]

The ACP recommendations, issued in October 2013, are as follows [43, 45] :

  • Asymptomatic adults without risk factors for CKD should not be screened for the disease (Grade: weak recommendation, low-quality evidence)

  • Adults with or without diabetes who are currently taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II-receptor blocker (ARB) should not be tested for proteinuria (Grade: weak recommendation, low-quality evidence)

  • In treating patients with hypertension and stage 1-3 CKD, clinicians should select pharmacologic therapy that includes either an ACE inhibitor (moderate-quality evidence) or an ARB (high-quality evidence) (Grade: strong recommendation)

  • Elevated low-density lipoprotein levels in patients with stage 1-3 CKD should be managed with statin therapy (Grade: strong recommendation, moderate-quality evidence)

The ASN, however, in response to the ACP recommendations, released a statement strongly advocating CKD screening even in patients without risk factors for CKD. The ASN pointed out that early CKD is usually asymptomatic and that catching and treating it early may slow its development. [44]

The nephrology society also disagreed with the ACP’s recommendation against testing for proteinuria, whether or not diabetes is present, in adults taking an ACE inhibitor or an ARB, emphasizing the importance of renal health assessment in adults on antihypertensive medication. [44]


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