Kidney Disease Screening in Fiji

Dr Angus RitchieNephrologist, Concord Repatriation General Hospital

CKD Program

Detect

Support

ConnectResearch

Prevent

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

Who Should We Screen?• Population• High Risk

Where Should We Screen?• Urban • Rural• Under served

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 Have Others Done?

ISN GO (ISN-COMGAN) Case studies• Nepal• Jalisco

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.