Screening in high-risk groups, like those at risk for chronic kidney disease, still deemed important
General health checks in the community setting do not reduce overall or disease-specific mortality, according to a new study by the Cochrane Collaboration, which conducts and publishes systematic reviews of health-care research. The findings are based on a review of 14 trials involving 182,880 people.
The review included randomized trials studying more than one screening intervention in multiple organ systems, and excluded those enrolling only older populations. All studies involved asymptomatic patients that were not considered to be in any high-risk groups for disease, like diabetics, who are at risk for kidney disease. All the studies compared groups who received general health checks with groups who did not. The review focused on all-cause and disease-specific mortality, as well as morbidity, hospitalization, patient worry, self-reported health, and cost. "This important review should not be interpreted as nihilistic; it focuses on the screening of asymptomatic people and does not apply to interventions prompted by clinical judgment or patient concern," wrote Stephanie Thompson and Marcello Tonelli of the Cochrane Collaboration in an editorial on the study.
Panel recommendations on general health checks
The editorial notes that general health checks are not widely recommended by national expert panels. Both the Canadian Task Force on the Periodic Health Examination and the United States Preventative Service Task Force recommend focused health checks guided by patient-specific risk factors.
Screening for chronic kidney disease
In August, the U.S. Preventive Services Task Force ruled that there is not enough evidence to assess the benefits and harms of routine screening of asymptomatic adults for chronic kidney disease. http://www.nephrologynews.com/articles/not-enough-evidence-to-screen-all-adults-for-ckd-task-force-says
This recommendation applies to asymptomatic adults without diagnosed CKD, diabetes or hypertension, the task force said, a distinction the National Kidney Foundation urged the panel to make. "The National Kidney Foundation recommends and advocates for screening of populations at risk for chronic kidney disease in contrast to widespread or mass screening," the NKF wrote in April in response to an Annals of Internal Medicine report that questioned whether widespread screening for chronic kidney disease is worthwhile.
"When contemplating screening, practitioners should focus on tests that are targeted to the patient's age, sex, and specific risk factors, and that are supported by high-quality evidence," wrote Thompson and Tonelli. "All screening tests (general health checks or focused screenings based on age, sex, or specific risk factors) have potential for benefits and harms, so consideration of patient preferences is critical, especially for those tests where such preferences vary between individuals or where the overall benefit:harm ratio is less favorable."
The Cochrane editorial is available here.