Many of the tests frequently conducted to screen for CKD have little clinical benefit on diagnosis and therapeutic management, according to the findings of a new study published in a research letter in JAMA Internal Medicine March 2.
Researchers at Brigham and Women's Hospital in Boston conducted a retrospective cohort study of 1,487 patients referred for initial evaluation of CKD from 2010 to 2013. They then reviewed nephrology progress notes to ascertain the presumed cause of CKD and whether a specific test was documented that specifically contributed to, confirmed, or established the underlying diagnosis and or any management decision related to CKD. Frequently obtained tests included measurement of calcium, hemoglobin, phosphate, urine sediment, parathyroid hormone levels, and many others.
The researchers found that tests such as serum protein electrophoresis and screening for antinuclear antibody, C3, C4, hepatitis C, hepatitis B and antineutrophil cytoplasmic antibody were obtained frequently, up to 68% of the time, despite infrequently affecting disease diagnosis or management. Urine protein quantification and hemoglobin A1c had the highest rates of impact on diagnosis and/or management among all of the tests obtained.
"This study suggests that reflexively ordering several tests for CKD evaluation and management may be unnecessary," said Mallika Mendu, MD, MBA, a physician in the Division of Renal Medicine at BWH and lead author of this study. "An evidence-based, targeted approach based on pretest probabilities of disease for diagnosis and management may be more efficient and reduce cost."
The researchers say that next steps will be to make clinical recommendations on what specific tests to avoid and which ones are needed in CKD evaluation.