Re-evaluating national screening for chronic kidney disease in the UK

Chronic kidney disease (CKD) is a major cause of mortality and morbidity that is often diagnosed late. Data from a large medical records study found a high prevalence of undiagnosed stage 3 kidney disease (62-96%) across five high income countries.1 An estimated 11-13% of the global population have diagnosed CKD,2 and it is independently associated with increased risk of cardiovascular disease, end stage kidney disease, and all-cause mortality.

CKD is increasingly common in the ageing UK population, with a prevalence of 7.4% among women and men 60-79 years of age in England and 29% in adults older than 80 years of age in 2021.3 It is responsible for 40 000-45 000 premature deaths and £1.5bn (€1.7bn; $2bn) in expenditure each year,4 with most people dying from cardiovascular disease rather than end stage kidney disease.5 Despite the health and financial cost, most people don’t know they have CKD until they are screened or experience symptoms in the later stages of disease.

The UK National Screening Committee recommended against a population screening programme for CKD in 2011 because the costs outweighed the benefits.6 Although CKD has attributes amenable to a screening programme,7 such as a long asymptomatic period8 and well defined stages of disease, at the time there was no effective treatment or evidence that screening would improve outcomes in those with a positive result.6 In March 2022, however, the National Institute for Health and Care Excellence (NICE) approved sodium-glucose cotransporter-2 (SGLT2) inhibitors for treatment of diabetic and non-diabetic kidney disease. SGLT2 inhibitors are generally safe and have been shown to significantly reduce CKD progression, end …