Glomerular Filtration Screening Should Not Be Universal
May lead to false diagnosis of kidney disease in women and elderly
THURSDAY, July 31 (HealthDay News) -- Estimated glomerular filtration rate (eGFR) should not be used to universally screen for chronic kidney disease and should be restricted to high-risk groups due to the potential to falsely diagnose women and particularly the elderly, according to two articles published online July 30 in the Clinical Journal of the American Society of Nephrology.
In the first article, Richard J. Glassock, M.D., from the University of California Los Angeles, and a colleague suggest that using eGFR as a form of universal screening for chronic kidney disease is not cost-effective and may actually cause harm. They note that current formulas for calculating eGFR and guidelines for staging eGFR do not take age- and gender-associated declines into account or require other evidence of kidney disease. This may result in the erroneous classification of female and elderly individuals, the authors argue.
In the second article, Michal L. Melamed, M.D., and colleagues from Albert Einstein College of Medicine, Bronx, N.Y., note that universal screening is not the purpose of reporting eGFR and is not justified, but high-risk groups should be tested by eGFR and urinary albumin. They agree that the current staging system leads to high estimates of the prevalence of chronic kidney disease. Many of these individuals are elderly with only marginally lower GFRs and no clear therapeutic implications, but many also have serious and progressive renal disease that is not diagnosed or treated.
"Identifying undiagnosed and, thus, untreated chronic kidney disease is admirable and will undoubtedly boost the numbers of individuals who seek care from which they can potentially benefit," William M. Bennett, M.D., from Northwest Renal Clinic in Portland, Ore., writes in an accompanying editorial. "However, this strategy will also counterproductively create a population of people for whom this diagnosis is false."