Screening everyone 35 and older for chronic kidney disease would save lives

Screening all U.S. residents over 35 for chronic kidney disease would increase life expectancy, reduce the number of people requiring dialysis or transplant, and provide good value in health care spending, Stanford Medicine researchers have found.

Chronic kidney disease affects 37 million people in the United States, or 15% of U.S. adults. Diabetes and high blood pressure are responsible for two-thirds of cases. Annual Medicare spending on CKD is $87 billion and an additional $37 billion is spent annually on kidney replacement therapy.

“CKD is often clinically silent until patients reach late-stage kidney disease, so many people with early-stage CKD are unaware they have it,” said Marika Cusick, a PhD candidate in health policy at Stanford Medicine and lead author of the study published in the Annals of Internal Medicine. “By screening for CKD, we can diagnose and treat it at an earlier stage, improving life expectancy and reducing the risk of progressing to late-stage kidney disease, which is deadly and costly.”

A new class of drugs, sodium-glucose cotransporter-2 inhibitors, have been found to slow the progression of kidney disease. These drugs, used to treat Type 2 diabetes and approved by the Food and Drug Administration about 10 years ago, changed the discussion over whether screening for early-stage CKD improves clinical outcomes, Cusick said.

Screening for CKD involves testing for albuminuria, the presence of albumin, a type of protein, in urine. Its presence in urine is an indicator of kidney disease.

For their study, the researchers used data from the National Health and Nutrition Examination Survey, an annual nationally representative survey by the National Center for Health Statistics to assess the health of some 5,000 adults and children in the United States. They then extrapolated their results to the full U.S. adult population aged 35 years and older, conducting a cost-effectiveness analysis of screening for albuminuria with and without SGLT2 inhibitors to the current standard of care for CKD.

The authors assessed costs, quality-adjusted life years and incremental cost-effectiveness ratios. They found that screening, in addition to using SGLT2 inhibitors, the 158 million persons aged 35 to 75 years in the United States would prevent the need for dialysis or kidney transplant in 398,000 to 658,000 individuals during their lifetime, depending on the frequency of screening.

Though the researchers found that adding a one-time screening that included SGLT2 inhibitors would increase total lifetime health care costs from $249,800 to $259,000 for 55-year-olds, they believe the intervention provides good value when considering the dollars spent on treating chronic kidney disease and the health benefits.

“Advanced kidney disease harms the health of Americans, places burdens on families and caregivers, and is extremely costly for the health care system to manage,” said Jeremy Goldhaber-Fiebert, PhD, professor of health policy and senior author of the study. “This analysis shows that, while it is a substantial undertaking, screening to detect chronic kidney disease before it advances and providing effective new treatments improves health and represents good value for the money and resources used.”

The other Stanford Medicine authors are Rebecca L. Tisdale, MD, MPH; Glen M. Chertow, MD, MPH; and Douglas K. Owens, MD, MS.

Funding: Marika Cusick is supported by the Agency for Health Research and Quality (T32HS026128). Rebecca Tisdale was supported by the Veterans Administration Office of Academic Affairs Advanced Fellowship in Health Services Research during this work. Glenn Chertow is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK085446).