title: Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: a systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline.
abstract: BACKGROUND
  Screening and monitoring for chronic kidney disease (CKD) could lead to earlier interventions that improve clinical outcomes.
  
  
  OBJECTIVE
  To summarize evidence about the benefits and harms of screening for and monitoring and treatment of CKD stages 1 to 3 in adults.
  
  
  METHODS
  MEDLINE (1985 through November 2011), reference lists, and expert suggestions.
  
  
  METHODS
  English-language, randomized, controlled trials that evaluated screening for or monitoring or treatment of CKD and that reported clinical outcomes.
  
  
  METHODS
  Two reviewers assessed study characteristics and rated quality and strength of evidence.
  
  
  RESULTS
  No trials evaluated screening or monitoring, and 110 evaluated treatments. Angiotensin-converting enzyme inhibitors (relative risk, 0.65 [95% CI, 0.49 to 0.88]) and angiotensin II-receptor blockers (relative risk, 0.77 [CI, 0.66 to 0.90]) reduced end-stage renal disease versus placebo, primarily in patients with diabetes who have macroalbuminuria. Angiotensin-converting enzyme inhibitors reduced mortality versus placebo (relative risk, 0.79 [CI, 0.66 to 0.96]) in patients with microalbuminuria and cardiovascular disease or high-risk diabetes. Statins and β-blockers reduced mortality and cardiovascular events versus placebo or control in patients with impaired estimated glomerular filtration rate and either hyperlipidemia or congestive heart failure, respectively. Risks for mortality, end-stage renal disease, or other clinical outcomes did not significantly differ between strict and usual blood pressure control. The strength of evidence was rated high for angiotensin II-receptor blockers and statins, moderate for angiotensin-converting enzyme inhibitors and β-blockers, and low for strict blood pressure control.
  
  
  CONCLUSIONS
  Evidence about outcomes was sometimes scant and derived from post hoc analyses of subgroups of patients enrolled in trials. Few trials reported or systematically collected information about adverse events. Selective reporting and publication bias were possible.
  
  
  CONCLUSIONS
  The role of CKD screening or monitoring in improving clinical outcomes is uncertain. Evidence for CKD treatment benefit is strongest for angiotensin-converting enzyme inhibitors and angiotensin II-receptor blockers, and in patients with albuminuria combined with diabetes or cardiovascular disease.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Minneapolis, Minnesota, USA. howard.fink@va.gov
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Greer
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Dominic
authors.initials: D
authors.lastname: Rossini
authors.forename: Sameea
authors.initials: S
authors.lastname: Sadiq
authors.forename: Srilakshmi
authors.initials: S
authors.lastname: Lankireddy
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
mesh_terms: D000328:Adult; D000419:Albuminuria; D002908:Chronic Disease; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D008403:Mass Screening; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors