Screening for Prevention

Vassalotti is National Kidney Foundation’s chief medical officer and co-principal investigator of the kidney disease screening project, which includes the NKF, the Centers for Disease Control and Prevention, the Chronic Diseases Research Group and the U.S. Renal Data System.

This may sound like a rhetorical question, but what advantages does a kidney screening program bring to the table?
This is a targeted screening for chronic kidney disease, which has been shown to be beneficial in identifying people with earlier stages of disease. There’s evidence that it’s cost effective. There are several studies that have shown that. It’s exciting that we have state-based screening programs that are going to be rolled out in four states as a demonstration project. At the state level, chronic kidney disease hasn’t really existed until recently; it’s all been about end-stage renal disease and mostly cost-focused on the Medicare system. Now, for the first time, we have the CDC recognizing chronic kidney disease, and we have some departments of health at the state level addressing chronic kidney disease, often in the diabetes programs. Now we have the state-based screening project. Ultimately, we’d like to demonstrate the benefits are improved outcomes in terms of the things that are important to patients, including cardiovascular disease, cardiovascular events and decreased progression of CKD to ESRD. Demonstrating improved outcomes is not what this is really about. This is about feasibility, identifying the at-risk populations, about the feasibility of having people return in one year, what the percent is of CKD that will be detected in this program, what the engagement is with the physician. It’s going to be 100 people at eight sites in four states.

Can you explain what an individual can expect when he or she shows up for a screening under this new program?
We’ve looked at KEEP (the NKF Kidney Early Evaluation Program), and the CDC’s NHANES (National Health and Nutrition Examination Survey), and we looked at the simplest factors to identify patients with CKD. This program came up with three: pre-existing diabetes, self-reported hypertension, and age over 50. The beauty of that is that those are three very simple things you can ask anyone. Participants can expect some media to be involved. There will be an informed consent form. Their blood pressure, height and weight will be determined, so we’ll get a body mass index. They’ll have urine and blood collected. The blood test will include the glucose hemoglobin A1C, the creatinine to estimate the GFR, the lipid profile, and the urine test will be the urinary albumin-to-creatinine ratio. The entire process will take about 45 minutes.

How do you get patients to come in for the screenings?
We want to make sure we get 100 people, and want to make sure every single person meets those three entry criteria. We’re going to have some local media. The local National Kidney Foundation will implement this. In New York, they may pick a community center in the Bronx or in Minnesota they may pick an Indian reservation. It’s going to attract different kinds of people. With this kind of media attention, we have to be a little concerned that we may have 500 people showing up for an event. The kind of things we’ll try to do is have some media locally, and have potential participants call the local NKF to make an appointment.