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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.077 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.017 | 0.018 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".