- Kenny Lin, MD
In patients without diabetes or hypertension, there is not enough evidence to assess benefits and harms of screening for chronic kidney disease with a serum creatinine level or urine albumin testing, the U.S. Preventive Services Task Force reported yesterday. A 2011 AFP article on chronic kidney disease detection and evaluation noted that multiple organizations recommend screening in patients with cardiovascular disease or diabetes, and a systematic review performed to support the USPSTF recommendation found that angiotensin-converting enzyme inhibitors slowed progression to end-stage renal disease and decreased mortality if prescribed in the early stages of this condition. However, few studies included patients without diabetes or hypertension.
For family physicians, the bottom line from this recommendation is that there is no clinical indication for ordering a basic metabolic profile or urinalysis in an asymptomatic patient as part of a preventive health evaluation. Ordering such unnecessary tests frequently does more harm than good, and has been discouraged by the AAFP-supported Choosing Wisely initiative and a previous AFP editorial.
Tuesday, August 28, 2012
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Good reminder for cost savings directly and indirectly by inappropriate screening.
ReplyDeleteKidney disease is a common consequence of a wide range of inappropriate actions. Kidney disease vs primary care is worth a review.
Kidney disease results in universal coverage due to this one time Medicare expansion. I find it interesting that disease motivation manages to keep getting increases in budgeting (8 billion) and basic services for most Americans fall behind. Kidney workforce increases while primary care falls behind as a result of different policies.
Make no mistake, those pushing non-communicable diseases have their eyes on the prize as indicated by chronic kidney disease.
But what we need first of all is universal coverage for basic health services for about 10 - 15 years with a tripling of FM grads. After we expand and support the primary care capacity for nearly all Americans then we can consider expansions of coverages for various diseases and technologies.
And we have a chance for addressing diseases earlier and less expensively, even in the complex populations left behind - most Americans.