UKKW news: Debate – population screening for CKD in those aged over 50 years
The motion “This house believes in population screening for chronic kidney disease (CKD) in people aged over 50 years” generated lively debate at UK Kidney Week 2026 in Harrogate. A poll held before the discussion indicated strong support for the motion, with 79% of the 67 votes cast being in favour.
For the motion
Speaking in favour, Asheesh Sharma (Consultant Nephrologist, Royal Liverpool University Hospital) began by providing some historical context on screening policy. In 2011, the UK National Screening Committee rejected the introduction of population screening for CKD on the grounds that treatment options were limited to delay or prevent disease progression once early CKD was detected. At around this time, a Canadian analysis estimated the cost per quality adjusted life year (QALY) gained by screening was $C20,000 (about £11,900) for people with type 2 diabetes. In the population without diabetes, this leapt to $C500,000 (£297,000).
He argued that the landscape has now changed significantly and that the prevailing “nihilism” towards early detection must be challenged. Against a backdrop in which non-communicable diseases account for 74% of global deaths, and mortality from stroke and ischaemic heart disease are falling, CKD stands out as a condition with rising mortality. Existing NHS Health Checks, offered every 5 years from the age of 40 years, have helped to reduce rates of cardiovascular disease but are unable to detect CKD as eGFR and uACR testing are not included.
He also highlighted recent modelling from the US suggesting that, with the availability of new treatments, screening individuals aged 50–75 years every 5 years has become more cost-effective. When followed by the initiation of RAASi/SGLT2i treatment where appropriate, the cost of screening is reduced to US $120,000 (£90,000) per QALY. This, he suggested, represents a step-change compared with earlier analyses and supports reconsideration of population-based screening.
Against the motion
Speaking against, Kristin Veighey (GP with Renal Interest, University of Southampton) reminded the audience that screening must offer more benefit than harm, particularly when targeting apparently healthy people. She listed a number of potential risks of screening: false positives or false negatives; over-diagnosis of conditions that may not cause harm during an individual’s lifetime; over-treatment, particularly in the elderly; exacerbation of health inequalities; and increased anxiety for individuals receiving a CKD diagnosis.
She also pointed to the risk of lead-time bias in screening programmes results. Longer time spent living with the condition does not necessarily mean increased life expectancy – only that diagnosis was made earlier in the lifespan.
Practical challenges also remain, such as how individuals with incomplete test findings should be managed (e.g. patients with declining eGFR but no uACR test result, or those with reduced eGFR on first testing who do not return for a second test). Early-stage CKD (eGFR 60–90 mL/min/1.73 m2) also raises questions about plans for follow-up.
She commented that although eGFR and uACR tests are reliable for ruling out CKD if the results are normal, their value in making diagnoses is more variable. Their positive predictive value can be just 50%–70% in populations without diabetes. These tests are most accurate in those with pre-existing risk factors, such as hypertension or diabetes – groups that are already subject to screening for CKD.
Questions from the floor
The debate stimulated thoughtful contributions from the delegates. Professor Jim Burton asked whether expanding screening was prudent given that many patients with diagnosed CKD are not receiving guideline-directed therapy. He suggested that this gap should be addressed before using resources to identify more people who may also not receive optimised therapy. The speakers agreed that these aims should be tackled in parallel.
Outcome
Following the debate, support for the motion had shifted considerably compared with the earlier poll. The post-debate vote recorded 60 votes for and 53 against, meaning that the motion was carried with 53% in favour.
