Statement from the National Kidney Foundation on Media Reports of USPSTF Considering Kidney Disease Screening
May 24, 2022, New York, NY —The National Kidney Foundation (NKF) is encouraged by reports the United States Preventative Services Task Force (USPSTF) may consider issuing new guidelines for kidney disease screening. NKF and the Coalition for Kidney Health have long been advocating for USPSTF to revise its CKD recommendations. A statement from Sylvia Rosas, MD, NKF President-elect and Associate Professor of Medicine, Harvard Medical School, and Joseph Vassalotti, MD, Chief Medical Officer for the NKF follows:
“Ultimately, CKD is a health equity issue – African Americans are 3 – 4 times more likely to develop kidney failure than Whites. If we can identify individuals with CKD earlier – at a more manageable stage of their disease – we can slow disease progression and help achieve better outcomes for all populations, but especially those at highest risk for kidney failure. The news that the USPSTF has agreed to review kidney disease screening again, is welcome. However, no timeline for future recommendations has been set. The USPSTF must act and act soon if we ever hope to adequately address inequity in CKD care.”
- Sylvia Rosas, MD, NKF President-elect and Associate Professor of Medicine, Harvard Medical School
“Randomized trials have demonstrated kidney and cardiovascular protection using new CKD therapeutics that increase the potential outcome and cost benefits of CKD diagnosis compared to 2012 when USPSTF last reviewed CKD screening. Overwhelming evidence from clinical trials shows the sodium glucose co-transporter-2 (SGLT-2) inhibitor drug class has efficacy in slowing CKD progression and reducing risk of cardiovascular events, particularly heart failure hospitalization, in CKD patients with Type-2 Diabetes Mellitus (T2DM), as well as without diabetes. The absence of screening guidance from the USPSTF contributes to the underdiagnosis of CKD, especially among socioeconomically disadvantaged populations.”
- Joseph Vassalotti, MD, Chief Medical Officer for the National Kidney Foundation.
Additional Background on Kidney Disease and the USPSTF:
Chronic kidney disease (CKD) is the tenth leading cause of death in the United States, affecting an estimated 37 million Americans. Despite being preventable and treatable, CKD is too often not intensively managed until a patient has progressed to kidney failure, resulting in costs to the Medicare program that exceed $153 billion annually.
The USPSTF, which is charged with providing evidence-based recommendations on clinical preventive services, does not offer any recommendations for CKD screening, even as 90 percent of individuals with CKD are undiagnosed. CKD testing is non-invasive and inexpensive. If CKD is detected and diagnosed, its progression can be slowed or stopped and associated cardiovascular risks reduced. Unfortunately, most kidney patients never learn they have kidney disease because they die prematurely from avoidable cardiovascular events.
Current evidence supports testing of individuals at risk for CKD, including individuals with diabetes, hypertension, cardiovascular disease, family history of kidney disease and individuals with a history of acute kidney injury as recommended by the NKF Kidney Disease Outcomes Quality Initiative (KDOQI), the American Diabetes Association (ADA) and the Kidney Diseases Improving Global Outcomes (KDIGO). In addition, there are several interventions that may not effect CKD progression, but reduce risk of cardiovascular disease, including statin-based therapies and the glucagon-like peptide receptor agonists (GLP-1 RA) drug class for T2DM. Observational studies have shown multidisciplinary care that may include a dietitian, pharmacist and nephrologist is also associated with improved outcomes for T2DM with CKD.
Prioritizing the development of a USPSTF CKD screening recommendation is foundational to achieving the health equity potential of new race-free clinical algorithms in kidney disease. In September 2021, the NKF-American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommendedthe adoption of a new race-free equation to minimize potential consequences that disproportionately affect any one group of individuals. Removing race correction from clinical algorithms is important to society to avoid implying a biologic cause for race, which is a social construct. Kidney health equity will require targeted CKD testing and improved access to care, including disease modifying medications.
About National Kidney Foundation
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.