Screening programmes for early detection of chronic kidney disease in the USA and other English-speaking countries (Canada, Australia and UK): a systematic literature review.

OBJECTIVES: To describe screening programmes for early chronic kidney disease (CKD) in the USA and other English-speaking countries (Canada, Australia and UK) involving patients with diabetes or hypertension, in addition to high-risk racial or ethnic groups. DESIGN: Systematic literature review. DATA SOURCES: Embase and MEDLINE (both via Ovid) between 1 January 2018 and 17 October 2023. ELIGIBILITY CRITERIA: CKD screening programmes in patients with diabetes and/or hypertension in the targeted countries were included. DATA EXTRACTION AND SYNTHESIS: Publications meeting the review objectives and prespecified population, intervention, comparator, outcome and eligible study design types were identified. Full-text publications were assessed for quality by two independent reviewers. For randomised controlled trials, quality/risk of bias (ROB) was assessed using version 2 of the Cochrane ROB tool for randomised trials; for observational longitudinal or prospective studies and non-randomised trials, quality/ROB was assessed using the Newcastle-Ottawa Scale. RESULTS: Of 5542 records identified from database searches, 21 studies were included. Of these, the majority (13 studies) screened patients with diabetes and/or hypertension. Screening programmes were described in 16 studies; the remaining 5 reported CKD prevalence. Of 30 643 162 pooled participants, 6 413 466 (weighted mean: 21%) received complete screening for CKD (ie, evaluation of albumin-to-creatinine ratio plus estimated glomerular filtration rate). The weighted mean prevalences of any type of CKD testing in patients with diabetes or hypertension were 33% and 12%, respectively. For the pooled population of 24 608 indigenous persons or underserved communities, the weighted mean prevalence of CKD screening was 91%. Weighted mean prevalences for any type of CKD testing were 22% (n=30 705 837) in primary care and 93% (n=26 640) in community outreach settings. Follow-up testing was infrequent or not reported in most studies. CONCLUSIONS: These findings indicate a low prevalence of CKD screening of high-risk patients, particularly in primary care. Contrary to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, most high-risk patients studied received incomplete screening. Lack of adherence to KDIGO guidelines on CKD screening may result in delays in CKD diagnosis and missed opportunities for therapy. PROSPERO REGISTRATION NUMBER: CRD42023492433.