Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the American College of Physicians

• Published in: Annals of internal medicine Vol. 159; no. 12; pp. 835 - 847
• Main Authors: QASEEM, Amir, HOPKINS, Robert H, SWEET, Donna E, STARKEY, Melissa, SHEKELLE, Paul
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 17-12-2013
• Subjects: Adult; Adults; Angiotensin Receptor Antagonists - adverse effects; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Asymptomatic Diseases - therapy; Biological and medical sciences; Disease Progression; Drug Therapy, Combination; Evidence-based medicine; Gemfibrozil - adverse effects; Gemfibrozil - therapeutic use; General aspects; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypolipidemic Agents - adverse effects; Hypolipidemic Agents - therapeutic use; Internal medicine; Kidney - physiopathology; Kidney diseases; Kidneys; Mass Screening; Medical sciences; Medical screening; Monitoring, Physiologic; Nephrology; Nephrology. Urinary tract diseases; Prevention and actions; Proteinuria - diagnosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - physiopathology; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; United States; North America; America; Kidney disease; Urinary system disease; Physician; Chronic kidney disease; Medical screening; Recommendation; Medicine; Clinical stage; Treatment; Learned society; Surveillance; Professional practice; Renal failure
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-159-12-201312170-00726

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the screening, monitoring, and treatment of adults with stage 1 to 3 chronic kidney disease.
This guideline is based on a systematic evidence review evaluating the published literature on this topic from 1985 through November 2011 that was identified by using MEDLINE and the Cochrane Database of Systematic Reviews. Searches were limited to English-language publications. The clinical outcomes evaluated for this guideline included all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, chronic heart failure, composite vascular outcomes, composite renal outcomes, end-stage renal disease, quality of life, physical function, and activities of daily living. This guideline grades the evidence and recommendations by using ACP's clinical practice guidelines grading system.
ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence)
ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker. (Grade: weak recommendation, low-quality evidence)
ACP recommends that clinicians select pharmacologic therapy that includes either an angiotensin-converting enzyme inhibitor (moderate-quality evidence) or an angiotensin II-receptor blocker (high-quality evidence) in patients with hypertension and stage 1 to 3 chronic kidney disease. (Grade: strong recommendation)
ACP recommends that clinicians choose statin therapy to manage elevated low-density lipoprotein in patients with stage 1 to 3 chronic kidney disease. (Grade: strong recommendation, moderate-quality evidence).