Opportunistic in-hospital screening for kidney disease using the Kidney Health Check

摘要

Background: Chronic kidney disease (CKD) is a major public health issue and early detection may prevent morbidity and mortality. Screening for CKD is simply assessed using the Kidney Health Check (KHC), a compilation of blood pressure (BP), estimated glomerular filtration rate (eGFR) and urinalysis (UA). KHC screening of high risk hospital inpatients is recommended, but its implementation and cost-effectiveness is unknown. Aims: We aimed to determine the proportion of patients currently tested for all components of the KHC during an acute hospital admission, and to compare the estimated costs of screening and subsequent follow-up with other screening programs. Methods: A retrospective audit was conducted of consecutively admitted adult patients, and the frequency of BP, eGFR and UA testing recorded. Using published data, the likely costs and benefits of components of the KHC were estimated. Results: Two hundred patients (median age 75 years, range 20-98) were assessed. All had a documented BP and eGFR, and 55% had a UA, representing a complete KHC. Of the total, 141 (71%) had one or more abnormalities detected, and of 71 with an eGFR 60 mL/min per 1.73 m2, only 22 (31%) had a recorded diagnosis of CKD. Estimated costs of opportunistic in-hospital KHC screening are below those of current Australian screening programs. Conclusions: Hospital in-patients frequently have a full KHC and most have abnormalities detected. Opportunistic inpatient KHC screening would have little impact on hospital costs, but may result in significant health benefits. The KHC should be included in routine discharge documentation.