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Kidney Disease Screening in Fiji
Dr Angus RitchieNephrologist, Concord Repatriation General Hospital
What is Screening?• A strategy used in a population to identify the possible presence of an
as-yet-undiagnosed disease in individuals without signs or symptoms.
Why Screen?
• What is the argument against screening?
Albuminuria Stage
GFR Stag
eGFR
(mL/min/1.73m2)
Normal(urine ACR mg/mmol)
Male: < 2.5Female: <
3.5
Microalbuminuria
(urine ACR mg/mmol)
Male: 2.5-25Female: 3.5-
35
Macroalbuminuria
(urine ACR mg/mmol)Male: > 25Female: >
351 ≥90 Not CKD
unless haematuria, structural or pathological
abnormalities present
2 60-89
3a 45-59
3b 30-444 15-29
5<15 or on dialysis
How Should We Screen?• Height• Weight• Blood Pressure• Urinalysis – glucose, protein, blood• Kidney function – creatinine, eGFR
• Methods and cost
What Will We Do After Screening?• Treat with ACEI?• Repeat the assessment for outcomes?
• Opportunity for “Polypill” intervention• Aspirin• Statin• ACEI• Thiazide Diuretic or Beta Blocker
What Should We Do?• Plan a collaborative CKD
screening project• Do it • Study results, outcomes, costs• Act on the results
• ISN Clinical Research Program: Screening &Intervention Study• Fiji Ministry of Health• WHO• Research Partners
References1. Perico N, Bravo RF, De Leon FR, Remuzzi G. Screening for chronic kidney
disease in emerging countries: feasibility and hurdles. Nephrol Dial Transplant. 2009;24(5):1355–8.
2. Kirby T. Screening for chronic kidney disease shows promise. Lancet, 2010; 375:1240–1.
3. Obrador GT, et al. Prevalence of chronic kidney disease in the Kidney Early Evaluation Program (KEEP) México and comparison with KEEP US. KI Supplement, 2010;(116):S2–8.
4. Obrador GT, et al. Longitudinal analysis of participants in the KEEP Mexico's chronic kidney disease screening program. Arch Med Res, 2013;44(8):650–4.