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ACP's new guideline presents evidence-based recommendations
for screening, monitoring, and treatment of adults with stage 1-3
chronic kidney disease
PHILADELPHIA, October 22, 2013 -- The American College of
Physicians (ACP) recommends against screening for chronic kidney
disease (CKD) in asymptomatic adults without risk factors. ACP's
new clinical practice guideline, "Screening,
Monitoring, and Treatment of Stage 1-3 Chronic Kidney Disease",
was published today in Annals of Internal Medicine, ACP's
"There is no evidence that evaluated the benefits of screening
for stage 1-3 chronic kidney disease," said Molly Cooke, MD, FACP,
president, ACP. "The potential harms of all the screening tests --
false positives, disease labeling, and unnecessary treatment and
associated adverse effects -- outweigh the benefits."
The major risk factors for CKD include diabetes, hypertension,
and cardiovascular disease. The current evidence is insufficient to
evaluate the benefits and harms of screening in asymptomatic adults
with risk factors.
ACP recommends against testing for proteinuria in adults with or
without diabetes who are currently taking an
angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin II
receptor blocker (ARB).
For treatment, ACP recommends treating patients with
hypertension and stage 1-3 CKD with either an ACE inhibitor or an
ARB. ACP recommends a statin therapy to manage elevated low density
lipoprotein in patients with stage 1-3 CKD.
Head-to-head trials showed no difference in the outcomes between
ACE inhibitors or ARBs. The risk of adverse effects significantly
increased with an ACE inhibitor combined with an ARB combination
therapy, including cough, hyperkalemia, hypotension, and acute
kidney failure requiring dialysis.
ACP's guideline also includes advice to help physicians practice
high value care.
"Ordering lab tests is not going to have any impact on clinical
outcomes of asymptomatic patients with CKD without risk factors but
will add unnecessary costs to the health care system due to
increased medical visits and unnecessary tests," Dr. Cooke
ACP also found the evidence inconclusive for periodic laboratory
monitoring of patients diagnosed with stage 1-3 CKD.
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 137,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.