Screening to prevent kidney failure: Necessity, feasibility and delivery.

摘要

Optimal practices for renal screening to prevent kidney failure remain unknown. The original studies and systematic reviews conducted in this thesis shed light on many of the steps to determine how best to screen. Chapters 2, 3 and 4 focus on the necessity of screening for renal disease, in patients infected with E.coliO157:H7. Chapters 5 and 6 focus on the need to screen and manage potential complications of kidney impairment, including malnutrition and cardiovascular disease. Chapters 7 and 8 focus on the feasibility of screening, and examine the prevalence of renal insufficiency in the general and institutionalized elderly populations. In addition, they assess the overlap between various screening tests and highlight potential limitations in predictive equations used to assess glomerular filtration rate. Finally, Chapter 9 examines the delivery of screening in the health care system, and reviews the potential efficacy of computerized clinical decision support systems to improve current deficiencies in care. A future research agenda is described, to further elucidate best screening practices to improve renal care and prevent kidney failure and its complications.