The screening for chronic kidney disease among older people across Europe (SCOPE) project: findings from cross-sectional
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INTRODUCTION
Open Access
The screening for chronic kidney disease among older people across Europe (SCOPE) project: findings from cross-sectional analysis Andrea Corsonello1*, Ellen Freiberger2 and Fabrizia Lattanzio1 Editorial The scenario of CKD in the older population is known to be very complex. Among community dwelling older people there is a broad range of different functional levels ranging from fitness and robustness to frailty or disability. Impaired physical function, frailty and disability, cognitive impairment, depression, vision and hearing impairment, malnutrition, and sarcopenia all contribute to worsen health outcomes and to increase the use of health care resources, thus challenging health care systems. The benefits of preventing/slowing the progression of CKD among these patients have the potential to impact different social and health domains, e.g. reducing the need for long-term care and the cost related to caregiving. Thus, early identification of CKD represents a relevant issue to be addressed in the older population. At the end of 2013 the American College of Physicians (ACP) issued a statement against the usefulness of chronic kidney disease (CKD) screening for the general adult population [1]. Those recommendations were severely criticized by nephrologists, fully aware that early detection and intervention can slow the progression of CKD to renal failure. Noting the lack of involvement of nephrologists in the development of ACP statements, Molitoris claimed that “We should be committed to supporting all approaches that will change kidney disease from a silent disease too often discovered in its late stages to one that is identified when modifications can affect the progression of the disease [ … ]. The entire medical * Correspondence: [email protected] 1 Italian National Research Center on Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Cosenza, Italy Full list of author information is available at the end of the article
community must act sooner and enlist patients’ help in minimizing the comorbidities and progression that too often remain undetected until very late in the disease process” [2]. CKD impact on global health, either as a risk factor for morbidity and mortality or by causing cardiovascular disease. A recent systematic analysis of the Global Burden of Disease Study 1990–2017 [3] showed that over the past 27 years CKD burden has not declined to the same extent as many other important non-communicable diseases. However, CKD and its consequences remain largely preventable and treatable and deserves greater attention in global health policy decision making. Indeed, several studies suggest that screening for CKD in high-risk and older populations may represent a cost-effective approach to reduce progression to renal failure and CKD mortality [4–7]. Current screening measures rely on creatinine-based estimated glomerular filtration rate (eGFR). They are known to have some degree of inaccuracy when used in older people and to carry an increased risk of both overand under-diagno
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