Jocelyn Anderson and Liam G. Glynn

Nephrol Dial Transplant

A description of the pooled data was completed and chisquare tests were used to investigate the relation between article quality and journal quality. Analysis was carried out using SPSS (15.0) and a P-value of <0.05 was considered to indicate statistical significance.

Results. The final review included 301 articles. There were a variety of methods used to define CKD in original research articles. Less than 20% (n ¼ 59) of the articles adhered to the established international criteria for defining CKD. The majority of articles (52.1%) did not indicate the quantity of serum creatinine measurements used to define CKD. The impact factor or specialist nature of the scientific journal appears to have no bearing on whether or not published articles use the gold standard KDOQI guidelines for labelling a patient with a diagnosis of CKD.

Conclusions. This review of literature found that a variety of definitions are being used in original research articles to define CKD and measure kidney function which calls into question the validity and reliability of such research findings and associated clinical guidelines. International consensus is urgently required to improve validity and generalizability of CKD research findings.

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Stein Ivar Hallan1,2, Paul Stevens3

J Nephrol

Introduction: Screening for chronic kidney disease (CKD) has been increasingly advocated. However, several criticisms have been levied, and screening programs for CKD are not universally accepted.

Methods and results: We discuss the problems of CKD screening and suggest improvements in the diagnostic and therapeutic strategies. Current problems with CKD screening are related to the need for both more efficient screening strategies and better screening tests. Diabetes mellitus, hypertension and age above 60 years seem to be the most important inclusion criteria for a CKD screening program, but only a small and variable proportion of CKD cases detected progress to end-stage renal disease (ESRD). Recent studies suggest that all stages of CKD should be stratified by the presence or absence of albuminuria. This applies particularly to CKD stage 3 in which a large proportion of subjects do not progress any quicker than those without kidney disease. Reduced kidney function and albuminuria are also strong and independent predictors for cardiovascular events. Screening for CKD using existing laboratory databases combined with automated management and referral recommendations based on the available evidence base seems to be a promising strategy for efficient and more adequate handling of the large number of CKD patients.

Conclusion: Screening for CKD in the general population is still not recommended. However, high-risk groups like patients with diabetes mellitus or hypertension and subjects above age 60 should have their glomerular filtration rate estimated and be tested for albuminuria. Better interplay between primary and secondary care is needed for successful implementation of CKD clinical guidelines in general practice.

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