Samenvatting
Chronic kidney disease (CKD) is a global health problem with a prevalence of approximately 10%. CKD increases the risk of kidney failure as well as cardiovascular disease. Currently, screening is only recommended for individuals with known risk factors, such as hypertension or type 2 diabetes. Unfortunately, many high-risk individuals are not screened (in time), often leading to late diagnoses and limited treatment effectiveness.
This thesis investigated whether early detection of CKD can be improved through systematic screening, both in high-risk groups and in the general population. It shows that testing for albuminuria in high-risk patients in general practice, as recommended by current guidelines, is suboptimal. Furthermore, systematic screening of high-risk individuals is more effective through general practices than pharmacies.The thesis also explored a novel approach: a population-based screening program involving 15,000 Dutch individuals aged 45–80. The study found a high willingness to participate (nearly 60%), and 3.3% of participants had elevated albuminuria. Many of these individuals had newly diagnosed risk factors for CKD and cardiovascular disease, or previously known risk factors that were not adequately controlled. These individuals could benefit from early start of preventive treatment. However, only half of them visited their general practitioner after the screening. Analyses also showed that population-based screening can be cost-effective (€9,225 per quality-adjusted life year gained) and helps prevent the progression of kidney disease and cardiovascular events. Finally, the thesis demonstrated that reducing albuminuria with an SGLT2 inhibitor lowers the risk of kidney and heart problems. Persistent albuminuria, however, remains associated with a high risk, underscoring the need for additional treatments.
In conclusion, this thesis shows that systematic screening—particularly through population-based programs—can enable early detection and better treatment of CKD. Increasing awareness around screening and treatment is essential.
This thesis investigated whether early detection of CKD can be improved through systematic screening, both in high-risk groups and in the general population. It shows that testing for albuminuria in high-risk patients in general practice, as recommended by current guidelines, is suboptimal. Furthermore, systematic screening of high-risk individuals is more effective through general practices than pharmacies.The thesis also explored a novel approach: a population-based screening program involving 15,000 Dutch individuals aged 45–80. The study found a high willingness to participate (nearly 60%), and 3.3% of participants had elevated albuminuria. Many of these individuals had newly diagnosed risk factors for CKD and cardiovascular disease, or previously known risk factors that were not adequately controlled. These individuals could benefit from early start of preventive treatment. However, only half of them visited their general practitioner after the screening. Analyses also showed that population-based screening can be cost-effective (€9,225 per quality-adjusted life year gained) and helps prevent the progression of kidney disease and cardiovascular events. Finally, the thesis demonstrated that reducing albuminuria with an SGLT2 inhibitor lowers the risk of kidney and heart problems. Persistent albuminuria, however, remains associated with a high risk, underscoring the need for additional treatments.
In conclusion, this thesis shows that systematic screening—particularly through population-based programs—can enable early detection and better treatment of CKD. Increasing awareness around screening and treatment is essential.
| Originele taal-2 | English |
|---|---|
| Kwalificatie | Doctor of Philosophy |
| Toekennende instantie |
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| Begeleider(s)/adviseur |
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| Datum van toekenning | 14-mei-2025 |
| Plaats van publicatie | [Groningen] |
| Uitgever | |
| Gedrukte ISBN's | 978-94-6473-765-3 |
| DOI's | |
| Status | Published - 2025 |