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Early identification of kidney disease cost-effective only when directed at high-risk patients

Routine annual testing for abnormally high levels of protein in the urine an early marker of kidney malfunction and premature death should be limited to those with other risk factors and older Americans, a Johns Hopkins study indicates.

"Given the relatively inexpensive and safe nature of urine testing for proteinuria, physicians might assume that frequent screening is something worth doing for everyone, but that's probably not true," says L. Ebony Boulware, M.D., M.P.H., lead study author and assistant professor of medicine at Hopkins. "Our results show that for the majority of the U.S. population -- those without hypertension or diabetes -- annual screening can actually be quite costly and anxiety producing for patients if you factor in false positive or negative test results, and the subsequent tests they may require. Screening should be directed at people with substantial risk of developing kidney disease, or it should be performed on a less frequent basis, such as every 10 years."

In the Hopkins report, published in the Dec. 17 issue of The Journal of the American Medical Association, the investigators recommend that annual screening be limited to hypertensive patients age 30 and up, and adults age 60 and up.

Chronic kidney disease is a growing public health problem that contributes to high health care costs, the authors note. More than 10 million Americans have some kidney damage and more than 300,000 have end-stage renal disease, a number estimated to double by 2010. With no set guidelines for the urine screening test, physicians have varied in whether and how they check patients for early kidney disease.

"Patients should be aware of their potential risk of kidney disease, and ask their physicians if they should be tested, particularly if they have diabetes or hypertension, or are at least age 60," says senior study author Neil R. Powe, M.D., M.P.H., director of Johns Hopkins' Welch Center for Prevention, Epidemio
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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
16-Dec-2003


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