The Vital Need for a Chronic Kidney Disease Screening Recommendation

A federal screening recommendation from USPSTF would enable more Americans to have earlier awareness and opportunities for intervention to manage kidney diseases.

On June 3rd, the Congressional Kidney Caucus urged the development of a kidney disease screening recommendation for people at high risk of kidney failure in a letter to the United States Preventative Services Task Force (USPSTF) and the Agency for Healthcare Research and Quality (AHRQ), USPSTF’s parent agency. Spearheaded by Representative Larry Bucshon and Representative Suzan DelBene, the letter was signed by more than 40 bipartisan members of Congress and supported by ASN and multiple kidney health organizations. This builds on years of advocacy for federal screening disease recommendation by Congress, ASN, and the kidney health community. 

Noting the “federal government’s unique role and responsibility in the care of people with kidney diseases and kidney failure,” the members of Congress undersigned on the letter’s call for a “strategic federal response” to kidney diseases. Given this commitment, the letter  points out that a federal screening recommendation is needed to enable “earlier diagnosis and intervention to prevent and delay costly kidney failure.” 

Kidney diseases are the 10th leading cause of death in the United States and are closely associated with cardiovascular diseases and diabetes. Kidney diseases exacerbate the risk of death from both cardiovascular diseases and diabetes, and cardiovascular diseases are responsible for 40 to 50 percent of all deaths among people with late-stage kidney diseases. 

Despite this risk and recommendations of kidney health screening among people at high risk of kidney disease from KIDGO, KDOQI, the American Diabetes Association, and the American Heart Association (AHA)—including a 2023 definition of cardiovascular-kidney-metabolic health by the AHA—the early detection of kidney diseases remains scant. Less than 30 percent of people with cardiovascular diseases and diabetes are screened for kidney diseases while managing their diseases and kidney diseases are estimated to remain undetected in 90 percent of people with kidney diseases. 

A federal screening recommendation from USPSTF would add more authority to existing screening recommendations and enable more Americans to have earlier awareness and opportunities for intervention to manage kidney diseases. New therapies, such as SGLT2 inhibitors, ns-MRAs, and GLP-1 agonists have shown great ability to delay the progression of kidney diseases, adding new tools to existing methods of managing kidney health such as dietary and lifestyle changes. However, any intervention is reliant on first detecting kidney diseases and the letter notes that, absent screening, “more than 80 percent of more than 80 percent of eligible patients cannot access SGLT2 inhibitors, ns-MRAs, or other lifesaving therapies.”

While the USPSTF has finalized a research plan to consider a screening recommendation for kidney diseases, their approach only allows for the inclusion of evidence where the primary studied population are asymptomatic adults without a known diagnosis of chronic kidney diseases (CKD), excluding studies “in which patients were selected on the basis of having conditions associated with CKD (e.g., hypertension, diabetes),” populations at the highest risk for kidney diseases. USPSTF deems that screening in such populations is considered part of routine disease management and outside the scope of the task force. 

Addressing this concern, members of Congress noted that it is important that the “methodological approach adopted by USPTF does not inadvertently restrict access to essential screening for vulnerable populations” and that USPSTFs’ framework should recognize clinical diseases like diabetes and hypertension as independent risk factors” for kidney diseases.  

In January, ASN and the National Kidney Foundation (NKF) issued a joint statement urging USPSTF and raising concern that the final research plan “continues to focus on screening of only asymptomatic, low-risk individuals.” Noting that his approach may risk including evidence that supports screening for at-risk populations, ASN and NKF urged USPSTF to widen the evidence base it is considering  in order to “have a greater impact on increasing diagnosis of those with, or most at risk for CKD.”

In 2012, USPSTF declined to offer a screening recommendation for people with kidney diseases, in part because of  “insufficient evidence that identification and early treatment of CKD in asymptomatic adults without these conditions [hypertension, diabetes, and cardiovascular diseases] results in improved health outcomes.” Since this publication, multiple studies have shown the efficacy of early management of kidney diseases, particularly through SGLT2 inhibitors, ns-MRAs, and GLP-1 agonists. 

ASN will continue to advocate for the earlier detection of kidney diseases, including for a federal screening recommendation for kidney diseases. A final determination from USPSTF on a CKD screening recommendation is forthcoming.