Screening for chronic kidney disease

In the linked study (doi:10.1136/bmj.c5869), Manns and colleagues assess the cost effectiveness of using the estimated glomerular filtration rate (GFR) to screen the general population for chronic kidney disease.1 Screening to prevent disease is a topic that consistently generates debate, with mammography being a prime example.2 Screening recommendations pit clinical epidemiologists who specialise in screening evaluation against special interest groups and their key opinion leaders, with health policy makers and sometimes even the law making the decisions. Ironically, debates become the most heated when the net benefits are the smallest. Although screening for kidney disease has lacked the publicity of breast cancer screening, the principles and arguments are similar but the impact may be greater⇓.

Preventing the progression of kidney disease may reduce the expense and clinical consequences of end stage renal disease and prevent premature death from cardiovascular disease. Several recent articles have highlighted independent and significant relative risks associated with albuminuria and low estimated glomerular filtration rate for both end stage renal disease and mortality.3 4 These reports have already generated renewed …