The best treatment for chronic kidney disease (CKD) is early intervention. However, 90% of Americans with kidney diseases are unaware (1). For nearly a decade, ASN along with the broader kidney care community, has advocated for federal support of routine screening to identify kidney diseases and intervene earlier to stop or slow progression. One of the main goals of these advocacy efforts has been for the U.S. Preventive Services Task Force (USPSTF) to release official screening guidelines for CKD.
An independent, volunteer panel of physicians that offers evidence-based recommendations about clinical preventive guidelines, USPSTF first proposed a research plan for CKD screening in 2012 but ultimately recommended against the formation of official guidelines (2). But advocacy efforts continued, and, in 2022, USPSTF decided to reconsider its 2012 decision with the release of a new proposed evidence review for CKD screening with an open public comment period (3).
Following a rigorous development process including public comment, USPSTF released its Final Research Plan for Chronic Kidney Disease Screening (4) on June 12, 2023. Among the changes made to the final plan were clarifications of the targeted screening population and the addition of a sub-key question on the effectiveness of repeat screening for CKD.
Evidence shows that the greatest opportunity for CKD screening comes from targeting those with CKD risk factors such as hypertension and diabetes. Despite this evidence, USPSTF insisted on the exclusion of studies in which patients were selected due to preexisting conditions in both the Draft and Final Research Plans. ASN maintains that the exclusion of such studies would lead to an incomplete and misleading assessment of CKD.
Shortly after its release of the Final Research Plan, ASN and the National Kidney Foundation (NKF) released a joint statement acknowledging the plan as a step in the right direction while reiterating concern that the proposed research plan continues to focus on the screening of asymptomatic, low-risk individuals (5). ASN and NKF expressed concern that USPSTF overstates current clinical practice guidelines for screening in hypertensive populations, which list albuminuria testing as optional. In the case of individuals with diabetes, the statement also documents that only 40% of those individuals receive annual albuminuria screening (6).
While ASN is confident that the evidence will ultimately demonstrate the value of CKD screening, ASN continues to urge USPSTF to expand its approach and ultimately increase the diagnosis of those with or at most risk of CKD.
Recommendation development process
USPSTF follows a multistep process to develop its recommendations, starting with a research plan that guides the review of existing evidence, resulting in a recommendation based on that evidence. Throughout the process, USPSTF solicits and considers public and expert input to improve its work. The 2023 plan released for public comment included a proposed analytic framework, key and contextual questions, an approach to accessing health equity and variation in evidence across populations, and a research approach.
ASN was pleased to comment on the proposed plan and applauded USPSTF for undertaking the important review. ASN's comments addressed both the individual elements and questions posed by USPSTF in the research plan (7). ASN also identified several flaws with the proposed evidence review, raising concern that the study would meet the same fate seen in 2012. ASN expressed concern over the scope of the evidence review—particularly the exclusion of studies in which patients were selected due to preexisting conditions such as hypertension and diabetes.
A call to action
ASN and NKF remain committed to ensuring access to preventive care for all individuals living with and at risk of CKD in the United States and are jointly considering options for focusing attention on this development with multiple target audiences (5). In the meantime, an upcoming Clinical Practice Session at Kidney Week 2023 in Philadelphia, PA, titled “Screening for Kidney Diseases: A Call to Action” will be held on Thursday, November 2, 2023, from 10:30 AM EDT–12:30 PM EDT and will highlight opportunities to implement screening for kidney diseases, including collaborative care models, health and economic consequences, and special populations.
More information on Kidney Week 2023 can be found here: https://www.asn-online.org/education/kidneyweek/. ASN will update its membership and the community as it continues to advocate for earlier intervention in kidney care.
References
- 1.↑
National Kidney Foundation. Kidney disease: The basics. https://www.kidney.org/news/newsroom/fsindex
- 2.↑
Moyer VA; U.S. Preventive Services Task Force. Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157:567–570. doi: 10.7326/0003-4819-157-8-201210160-00533
- 3.↑
U.S. Preventive Services Task Force. Chronic kidney disease: Screening. July 7, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/chronic-kidney-disease-screening
- 4.↑
U.S. Preventive Services Task Force. Final Research Plan. Chronic kidney disease: Screening. July 13, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/document/final-research-plan/chronic-kidney-disease-screening
- 5.↑
ASN and NKF joint statement on the USPSTF final research. July 19, 2023. https://www.kidney.org/news/joint-statement-asn-and-nkf-uspstf-final-research-plan-ckd
- 6.↑
National Committee for Quality Assurance. Kidney Health Evaluation for Patients With Diabetes (KED). https://www.ncqa.org/hedis/measures/kidney-health-evaluation-for-patients-with-diabetes/
- 7.↑
Josephson MA. Letter to Drs. Mangione, Barry, and Nicholson, U.S. Preventive Services Task Force. February 15, 2023. https://www.asn-online.org/policy/webdocs/02.15.23.USPSTF.Letter.pdf
