一到三期慢性肾病筛检，监测：PSTF和美国医师学院临床实践指南的系统评价

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Screening for, Monitoring, and Treatment of Chronic Kidney Disease Stages 1 to 3: A Systematic Review for the U.S. Preventive                  Services Task Force and for an American College of Physicians Clinical Practice Guideline               

• Howard A. Fink, MD, MPH;
• Areef Ishani, MD, MS;
• Brent C. Taylor, PhD, MPH;
• Nancy L. Greer, PhD;
• Roderick MacDonald, MS;
• Dominic Rossini, MD;
• Sameea Sadiq, MD;
• Srilakshmi Lankireddy, MD;
• Robert L. Kane, MD; and
• Timothy J. Wilt, MD, MPH
  

+ Author Affiliations

•                            From Geriatric Research, Education, and Clinical Center and Center for Chronic Disease Outcomes Research, Minneapolis Veterans                           Affairs Medical Center; Minnesota Evidence-based Practice Center; University of Minnesota; and University of Minnesota School                           of Public Health, Minneapolis, Minnesota.
  

Abstract

Background: Screening and monitoring for chronic kidney disease (CKD) could lead to earlier interventions that improve clinical outcomes.                     

Purpose: To summarize evidence about the benefits and harms of screening for and monitoring and treatment of CKD stages 1 to 3 in                        adults.                     

Data Sources: MEDLINE (1985 through November 2011), reference lists, and expert suggestions.                     

Study Selection: English-language, randomized, controlled trials that evaluated screening for or monitoring or treatment of CKD and that reported                        clinical outcomes.                     

Data Extraction: Two reviewers assessed study characteristics and rated quality and strength of evidence.                     

Data Synthesis: No trials evaluated screening or monitoring, and 110 evaluated treatments. Angiotensin-converting enzyme inhibitors (relative                        risk, 0.65 [95% CI, 0.49 to 0.88]) and angiotensin II–receptor blockers (relative risk, 0.77 [CI, 0.66 to 0.90]) reduced end-stage                        renal disease versus placebo, primarily in patients with diabetes who have macroalbuminuria. Angiotensin-converting enzyme                        inhibitors reduced mortality versus placebo (relative risk, 0.79 [CI, 0.66 to 0.96]) in patients with microalbuminuria and                        cardiovascular disease or high-risk diabetes. Statins and β-blockers reduced mortality and cardiovascular events versus placebo                        or control in patients with impaired estimated glomerular filtration rate and either hyperlipidemia or congestive heart failure,                        respectively. Risks for mortality, end-stage renal disease, or other clinical outcomes did not significantly differ between                        strict and usual blood pressure control. The strength of evidence was rated high for angiotensin II–receptor blockers and                        statins, moderate for angiotensin-converting enzyme inhibitors and β-blockers, and low for strict blood pressure control.                     

Limitations: Evidence about outcomes was sometimes scant and derived from post hoc analyses of subgroups of patients enrolled in trials.                        Few trials reported or systematically collected information about adverse events. Selective reporting and publication bias                        were possible.                     

Conclusion: The role of CKD screening or monitoring in improving clinical outcomes is uncertain. Evidence for CKD treatment benefit is                        strongest for angiotensin-converting enzyme inhibitors and angiotensin II–receptor blockers, and in patients with albuminuria                        combined with diabetes or cardiovascular disease.                     

Primary Funding Source: Agency for Healthcare Research and Quality.

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