Lawmakers urge updated stronger guidelines on chronic kidney disease screening

Patients would benefit from stronger federal guidelines for screening for chronic kidney disease (CKD), according to lawmakers.
The U.S. Preventive Services Task Force (USPSTF) is considering revising its recommendation on CKD. That can’t come soon enough as CKD now is the 10th leading cause of death in the nation, according to a bipartisan group led by Rep. Larry Bucshon, MD (R-Indiana) and Rep. Suzan K. DelBene (D-Washington), co-chairs of the Congressional Kidney Caucus.
On June 3, they wrote to the Task Force to highlight “the critical need for early detection and management of this condition.” It exacerbates risk of cardiovascular disease and has disproportionately affected Black Americans with higher rates of CKD and kidney failure.

“Medicare’s expenditure on CKD and its progression underscore a severe financial and public health burden, borne most heavily by the federal government,” said the letter. “This situation calls for a strategic federal response, particularly targeting high-risk groups such as those with hypertension and diabetes.”
Apart from the human toll, Medicare now spends more than $136 billion managing care of people with CKD and more than $50 billion managing kidney failure through the end-stage renal disease benefit, the letter said.

Good treatments, low awareness

New “breakthrough therapies, such as sodium glucose transporter 2 (SGLT2) inhibitors and nonsteroidal mineralcorticoid receptor agonists (ns-MRAs), save kidneys, hearts, and lives,” the lawmakers said. But up to 90% of people with CKD don’t know about their condition, and just 30% of people with risk factors such as diabetes and hypertension are screened for the disease, they said. As a result, more than 80% of eligible patients are missing out on treatments that can prevent or slow the progression of CKD.
“A federal kidney disease screening recommendation would increase early detection and improve quality-of-life and physical functioning for millions of people, while preventing costly consequences including deaths, kidney failure, and cardiovascular complications,” the letter said.

What’s in place now

As for the current recommendation, the USPSTF website said it is out of date. The Task Force’s website lists the 2016 recommendation as inactive, and notes the previous evidence review and recommendation issued in 2012 may contain outdated information. Primary care physicians and clinicians should consult other sources for current evidence during the update period.
USPSTF has published an “Update in Progress for Chronic Kidney Disease: Screening.” Its draft research plan includes proposed key questions for review to weigh the effects and harms of screening for CKD vs. no screening.

Supporters

The letter from 44 members of Congress was sent to USPSTF Chair Wanda Nicholson, MD, MPH, MBA, and federal Agency for Healthcare Research and Quality Director Robert Otto Valdez, PhD, MHSA, which helps coordinate research for the Task Force.