The American College of Physicians recommends against screening for chronic kidney disease in asymptomatic adults without risk factors, according to new clinical practice guidelines published in Annals of Internal Medicine. In a statement issued Oct. 22, the American Society of Nephrology said they believe adults should be screened for kidney disease, which they call a silent killer
"There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease," said Molly Cooke, MD, FACP, president, ACP. "The potential harms of all the screening tests—false positives, disease labeling, and unnecessary treatment and associated adverse effects outweigh the benefits."
ACP also said it recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB).
The guidelines recommend treating patients with hypertension and stage 1-3 CKD with either an ACE inhibitor or an ARB. They also recommend a statin therapy to manage elevated low density lipoprotein in patients with stage 1-3 CKD. Head-to-head trials showed no difference in the outcomes between ACE inhibitors or ARBs, according to the guidelines. But the risk of adverse effects significantly increased with an ACE inhibitor combined with an ARB combination therapy, including cough, hyperkalemia, hypotension, and acute kidney failure requiring dialysis.
The guidelines also say there is insufficient evidence to support periodic lab monitoring of patients with stage 1-3 chronic kidney disease. "Ordering lab tests is not going to have any impact on clinical outcomes of asymptomatic patients with CKD without risk factors but will add unnecessary costs to the health care system due to increased medical visits and unnecessary tests."