By C. Nathan Okechukwu, M.D., Chairman, Department of Medicine
Recently, the American College of Physicians (ACP) issued clinical practice guidelines1 recommending against screening for early chronic kidney disease (CKD) in adults not showing symptoms and without risk factors for CKD. This controversial recommendation has led to a rebuttal by the American Society of Nephrology2.
These seemingly contradictory recommendations plant patients, and their healthcare providers, firmly in the uncomfortable and confusing center of this conversation. Given the importance and prevalence of CKD, I am perplexed why there is very little public discourse and awareness about this critical issue.
Chronic kidney disease is a condition whereby kidney damage leads to a decrease in your kidneys’ ability to do their job properly. The kidneys are responsible for eliminating toxic waste from our bodies, maintaining blood pressure, maintaining the pH of our blood within normal limits, keeping our bones healthy, preventing unsafe levels of certain chemical such as potassium from building up in the body and helping the body maintain a normal red blood cell count.
If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. It can lead to high blood pressure, low blood count, weak bones, poor appetite, fluid build up in the body, nerve damage and accumulation of potentially dangerous chemicals. On top of that, kidney disease also increases your risk of having heart disease.
These problems often happen slowly over a long period of time and CKD often begins with no symptoms at all until much later in its course. The causes of CKD include (but not limited to):
If kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.
In the United States, more than 25 million people currently live with CKD and many of them are completely unaware of their disease. CKD is the eighth leading cause of death in the United States and in Pennsylvania. Additionally, more than half-a-million US citizens are currently on dialysis or living with a transplant. As of 2011, total Medicare expenditure had risen to just over $549 billion. Of this, over 6% ($34.3 billion) was spent on dialysis alone!
It is important to note that while CKD (especially in the earlier stages) is largely asymptomatic, early diagnosis and treatment could slow progression of kidney disease and preserve kidney function.
Screening for CKD is simple and inexpensive and can detect early disease. Healthcare providers, armed with this information, can then take appropriate steps to identify and treat the cause of CKD, and also implement strategies to slow progression of the kidney disease.
Also, early detection enables patients and their care providers to select diagnostic and treatment options for other, co-existing diseases that are less likely to be damaging to the already impaired kidneys.
It is therefore important for patients, especially those at increased risk, to get screened for CKD and appropriate management begun by their healthcare practitioners. Talk to your primary care physician to find out if you’re at risk and to schedule a kidney screening test.
- Amir Qaseem, Robert H. Hopkins, Jr., Donna E. Sweet, Melissa Starkey, Paul Shekelle, for the Clinical Guidelines Committee of the American College of Physicians; Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2013 Dec;159(12):835-847.