PDF(Pubmed)
Abstract：
BACKGROUND: Regular monitoring is required to ensure that patients who have, or are at risk of, chronic kidney disease (CKD) receive appropriate management. Guidelines recommend regular testing of estimated glomerular filtration rate (GFR) and albuminuria. However, evidence suggests that albuminuria testing rates, specifically urine albumin-to-creatinine ratio (UACR), are suboptimal.
OBJECTIVE: To assess published evidence relating to the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying CKD across the course of progression.
METHODS: A systematic review of five bibliographic databases was conducted, supplemented by hand searches of relevant conference abstracts.
RESULTS: One study was identified that reported drivers of non-adherence to albuminuria testing guidelines. The largest barrier was the perception that testing does not impact patient management. Thirteen studies were identified that evaluated the impact of not identifying CKD patients. All included studies analyzed the effect of not identifying worsening CKD severity leading to late referral (LR). 12/13 studies reported only on clinical impact, and 1/13 reported on clinical and economic impact. LR led to higher costs and worse outcomes than early referral, including higher rates of mortality and worsened kidney replacement therapy preparation.
CONCLUSIONS: This systematic review demonstrates a gap in evidence exploring the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying patients in the early stages of CKD. Guideline-recommended testing allows timely identification, referral, and treatment for patients with, or at risk of, CKD, providing the best chance of avoiding the worsened outcomes identified in this review.
OBJECTIVE: To assess published evidence relating to the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying CKD across the course of progression.
METHODS: A systematic review of five bibliographic databases was conducted, supplemented by hand searches of relevant conference abstracts.
RESULTS: One study was identified that reported drivers of non-adherence to albuminuria testing guidelines. The largest barrier was the perception that testing does not impact patient management. Thirteen studies were identified that evaluated the impact of not identifying CKD patients. All included studies analyzed the effect of not identifying worsening CKD severity leading to late referral (LR). 12/13 studies reported only on clinical impact, and 1/13 reported on clinical and economic impact. LR led to higher costs and worse outcomes than early referral, including higher rates of mortality and worsened kidney replacement therapy preparation.
CONCLUSIONS: This systematic review demonstrates a gap in evidence exploring the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying patients in the early stages of CKD. Guideline-recommended testing allows timely identification, referral, and treatment for patients with, or at risk of, CKD, providing the best chance of avoiding the worsened outcomes identified in this review.
摘要：
背景：需要定期监测，以确保患者，或者有风险，慢性肾脏病（CKD）接受适当的管理。指南建议定期检测估计的肾小球滤过率（GFR）和蛋白尿。然而,证据表明蛋白尿检测率,特别是尿白蛋白与肌酐比值（UACR），是次优的。
目的：评估已发表的与不遵守白蛋白尿检测指南的驱动因素相关的证据，以及在整个疾病进展过程中未发现CKD的影响。
方法：对五个书目数据库进行了系统评价，辅以相关会议摘要的手工搜索。
结果：一项研究证实了不遵守白蛋白尿检测指南的驱动因素。最大的障碍是人们认为测试不会影响患者管理。确定了13项研究，评估了未识别CKD患者的影响。所有纳入的研究分析了未确定CKD严重程度恶化导致晚期转诊（LR）的影响。12/13研究仅报道了临床影响，1/13报告了临床和经济影响。与早期转诊相比，LR导致更高的成本和更差的结果，包括更高的死亡率和恶化的肾脏替代治疗准备。
结论：本系统综述表明，在探索不遵守白蛋白尿检测指南的驱动因素以及在CKD早期未识别患者的影响方面存在证据空白。指南推荐的测试允许及时识别，转介,以及对患者的治疗，或者有风险，CKD,提供避免本综述中发现的恶化结局的最佳机会.
目的：评估已发表的与不遵守白蛋白尿检测指南的驱动因素相关的证据，以及在整个疾病进展过程中未发现CKD的影响。
方法：对五个书目数据库进行了系统评价，辅以相关会议摘要的手工搜索。
结果：一项研究证实了不遵守白蛋白尿检测指南的驱动因素。最大的障碍是人们认为测试不会影响患者管理。确定了13项研究，评估了未识别CKD患者的影响。所有纳入的研究分析了未确定CKD严重程度恶化导致晚期转诊（LR）的影响。12/13研究仅报道了临床影响，1/13报告了临床和经济影响。与早期转诊相比，LR导致更高的成本和更差的结果，包括更高的死亡率和恶化的肾脏替代治疗准备。
结论：本系统综述表明，在探索不遵守白蛋白尿检测指南的驱动因素以及在CKD早期未识别患者的影响方面存在证据空白。指南推荐的测试允许及时识别，转介,以及对患者的治疗，或者有风险，CKD,提供避免本综述中发现的恶化结局的最佳机会.
