Don't Routinely Test for Kidney Disease in Those Without Symptoms: Experts
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MONDAY, Oct. 21 (HealthDay News) -- Screening for chronic kidney disease is not recommended for adults with no symptoms or risk factors such as diabetes, high blood pressure and heart disease, according to new guidelines from the American College of Physicians (ACP).
The group explained there isn't enough evidence to justify screenings for these people because the risks and potential problems of testing would outweigh any benefit.
"There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease," ACP president Dr. Molly Cooke, said in a news release issued by the group. "The potential harms of all the screening tests -- false positives, disease labeling, and unnecessary treatment and associated adverse effects -- outweigh the benefits."
In its new clinical practice guidelines published in the Oct. 22 Annals of Internal Medicine, the group also advised against testing for high levels of protein in the urine in adults with or without diabetes who are taking certain heart drugs, such as an ACE inhibitor or an ARB.
The ACP also recommended treating patients with high blood pressure and stage 1-3 chronic kidney disease with either an ACE inhibitor or an ARB, and they urged the use of statin therapy to manage high LDL ("bad") cholesterol levels in patients with stage 1-3 chronic kidney disease.
Although studies have shown no difference in outcomes between ACE inhibitor or ARB use, the guidelines cautioned that the risk of adverse effects are much higher with a combination therapy involving an ACE inhibitor and an ARB. Those side effects include cough, unhealthily high potassium levels, low blood pressure, and even acute kidney failure requiring dialysis.
The ACP guidelines also stated there is insufficient evidence to support periodic lab monitoring of patients with stage 1-3 chronic kidney disease. The group advised doctors to avoid unnecessary tests.
"Ordering lab tests is not going to have any impact on clinical outcomes of asymptomatic patients with chronic kidney disease without risk factors, but will add unnecessary costs to the health care system due to increased medical visits and unnecessary tests," Cooke explained.
-- Mary Elizabeth Dallas
SOURCE: American College of Physicians, news release, Oct. 21, 2013