Q&A: U.S. Task Force considers routine chronic kidney disease screening
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The United States Preventive Services Task Force added screening for chronic kidney disease to its list of preventive services under active consideration, according to a press release.
Organizations like the National Kidney Foundation (NKF) and the Coalition for Kidney Health have advocated for the approval of CKD screening since the last time the United States Preventive Services Task Force (USPSTF) considered it in 2012. In 2020, the two groups nominated CKD for another evaluation, referencing new medications and evidence. Nearly 2 years later, the USPSTF has added kidney disease to the list of services it will consider.
Healio sat down with Sylvia E. Rosas, MD, MSCE, nephrologist and epidemiologist at the Joslin Diabetes Center in Boston and president-elect of the NKF, to further discuss the possibility of routine CKD screenings.
Healio: What do you think has changed between now and the last time the USPSTF considered CKD screening in 2012?
Rosas: In the last 5 years or so, we've seen an increasing number of FDA approved medications for patients with diabetic kidney disease and without diabetes, that have slowed progression of kidney disease.
The last time we had a positive trial to slow progression to kidney failure in diabetes was for medications called ARBs, which stands for angiotensin receptor blockers, and that was in 2001. Now, we have a variety of new medications. One class is called SGLT2 inhibitors. We also have, more recently, another class of medications called nonsteroidal mineralocorticoid receptors. In addition to that, we have other promising medications that have been shown to slow or decrease the amount of protein that is in urine. Those are called GLP-1 inhibitors and are now under study to see if they slow progression to kidney failure too.
So, there's a series of new medications that show great promise to slow progression of kidney disease, but these can only work if we're able to identify the people who can benefit from these therapies.
Healio: The approval of a screening can take up to 3 years. What does that timeline look like?
Rosas: The task force follows guidelines when it comes to their approval process. It will take some time for them to convene the experts, then they will reach out to another group of individuals to review the literature and create a summary. Then they will post for comments and wait to hear from different stakeholders as well as request for evidence that has not been considered. They have a certain series of steps, and the process is transparent. I understand why the process takes longer than we would like because we don’t want them to recommend something that is not based on evidence.
Healio: What obstacles, if any, are in the way of the screening being approved?
Rosas: The task force may be considering other things for screening approval. The hierarchy of those items could potentially push CKD screening for high-risk individuals to the back of the list.
Healio: The Coalition of Kidney Health recently nominated CKD screening to the task force for consideration. Can you talk a bit about NKF’s role in that?
Rosas: Securing a USPSTF screening recommendation has been a long-time priority for the NKF but it has taken on renewed urgency, given the recent work they’ve done to eliminate race as a consideration in the diagnosis of kidney disease. As you know, in 2021, the NKF and ASN joint taskforce issued a report that recommends the adoption of the eGFR 2021 CKD-EPI Creatinine Equation that estimates kidney function without a race variable. NKF has been working tirelessly to facilitate its adoption in the nephrology community and beyond. However, a race-free algorithm is of limited value if people don’t get screened in the first place. We must do more to ensure that at-risk populations get screened and tested as part of a larger strategy to ensure high quality, equitable kidney care.
Healio: What would the approval of CKD screening by the USPSTF mean?
Rosas: CKD screening approval would raise awareness of kidney disease. There is a certain inertia in management because people have this erroneous belief that there’s nothing to be done about kidney disease. It is possible that some people that are at high risk will progress to kidney failure, but we will never know how many kidneys we can save if we don’t start screening early; if we don’t give patients medications; if we don’t treat kidney disease appropriately. We will fail if we don’t try.
So having an indication that USPSTF may approve CKD screening guidelines is fantastic because then we can identify our patients, give them appropriate management, treat their disease early and hopefully prevent people from needing dialysis or kidney transplantation.
Healio: Is there anything you would like to add?
Rosas: Screening for kidney disease involves both a urine test to check for albumin and blood test for creatinine. Patients at high risk for chronic kidney disease, such as individuals with diabetes, hypertension or a family history of kidney disease, should be monitoring their kidney health with these tests. Please visit our website at www.kidney.org if you are interested in learning more about kidney health.
References:
Letter of nomination. https://www.kidney.org/sites/default/files/2020-12-23_ckd_nomination_cover_letter_final.pdf Published Dec. 23, 2020. Accessed May 26, 2022.
Response letter. https://www.kidneynews.org/fileasset/KN/news/uspstf-CKD-nom-acceptance.pdf. Published Feb. 14, 2022. Accessed May 26, 2022.
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