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

logy and Clinical Research. "Physicians should understand which patients warrant periodic testing and subsequent treatment."

Boulware, Powe and colleagues assembled population data from the third National Health and Nutrition Examination Survey (NHANES III) and death statistics from a national mortality data file, then used that information to develop a computer program comparing the effectiveness of annual screening -- or no screening -- for proteinuria at different yearly intervals among hypothetical groups of healthy individuals and those with hypertension.

The screening strategy consisted of a urine test for proteinuria during an annual visit with a primary care physician. If results were positive, patients visited their doctor again for further testing, and if necessary, were referred to a kidney specialist or were prescribed medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II-receptor blockers (ARB) to slow the progression of kidney disease and lower the incidence of heart attacks and other problems.

In the no-screening strategy, patients did not undergo routine screenings, but those who had natural progression of kidney disease may have been screened by their physicians as symptoms occurred. Screening of all study patients occurred annually until age 75, or until they developed end-stage renal disease or died.

The research team's analysis found that to save one year of "high-quality" life (called a "quality-adjusted life-year" or QALY) among the general population would cost $282,818. Ratios of $50,000 to $100,000 per QALY are thought to be more reasonable in decisions about mass screening. Screening everyone resulted in 135 invasive kidney biopsies, seven complications from biopsies and complication costs of $9,116, but the prevention of only one new case of end-stage renal disease and seven deaths per 1 million people per year.

However, for those with hypertension, screenin

Contact: Karen Blum
Johns Hopkins Medical Institutions

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