title: Added value of screening for CKD among the elderly or persons with low socioeconomic status.
abstract: OBJECTIVE
  Three screening approaches were compared for their ability to detect CKD cases, and identify patients with CKD who have a higher rate of incident cardiovascular disease (CVD) events and renal function decline. Approach 1 was the traditional CKD screening approach, targeting only individuals with known diabetes, hypertension, or CVD history. Approach 2 was defined as Approach 1+elderly, and Approach 3 as Approach 1+low-socioeconomic status (SES) individuals.
  
  
  METHODS
  Data on 3411 individuals from the general population in The Netherlands were examined. Individuals aged >60 years were classified as elderly. Persons with low SES was defined as those with primary school or below primary school education. CKD was diagnosed during outpatient clinic visits. Individuals were followed for 9.4±2.6 years during four screening rounds.
  
  
  RESULTS
  At baseline, 16%, 29%, and 25% of the general population was to be screened and 36%, 59%, and 51% of the CKD (n=263) cases were detected in Approaches 1, 2, and 3, respectively. The numbers of individuals needed to screen to detect one CKD case were 5.6 in Approach 1 and 6.5 each in Approach 2 and 3. In Approach 2 the hazard ratio for incident CVD events was 1.87 (95% confidence interval [95% CI], 1.35 to 2.61) in detected and 1.92 (95% CI, 1.01 to 3.64) in undetected CKD cases compared with persons without CKD, whereas in Approach 3 these values were 2.31 (95% CI, 1.64 to 3.25) and 1.28 (95% CI, 0.77 to 2.13), respectively. In Approach 2, the rate of renal function decline was -1.37 ml/min per 1.73 m(2) per year in detected and -1.13 ml/min per 1.73 m(2) per year in undetected CKD cases. In Approach 3, these figures were -1.41 and -1.14 ml/min per 1.73 m(2) per year, respectively.
  
  
  CONCLUSIONS
  Adding persons with low SES, rather than adding elderly persons, to the traditional high-risk groups may help detect more persons with CKD who have a higher rate of future CVD events and renal function decline.
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, and p.vart@umcg.nl.
authors.forename: Priya
authors.initials: P
authors.lastname: Vart
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, and.
authors.forename: Sjimen A
authors.initials: SA
authors.lastname: Reijneveld
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, and.
authors.forename: Ute
authors.initials: U
authors.lastname: Bültmann
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Gansevoort
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D035862:Vulnerable Populations
keywords: CKD; cardiovascular disease; epidemiology and outcomes; renal progression