NEW YORK (Reuters Health) – Urine dipsticks are unreliable and cost-ineffective at screening children for chronic kidney disease, investigators report in the April issue of Pediatrics.

In 2007, the American Academy of Pediatrics stopped recommending screening urinalysis, but many doctors still include dipstick urinalysis in routine well-child care, notes the research team from Hershey Children’s Hospital in Pennsylvania.

Led by Dr. Deepa L. Sekhar, the researchers calculated the cost of screening dipstick urinalysis from the primary care practitioner’s perspective. Their data on the incidence of pediatric hematuria and proteinuria came from published reports involving 8954 children from a non-American cohort. Unfortunately, the data did not account for racial or ethnic factors that affect the incidence of chronic kidney disease.

The reports indicated that 1264 children (14.1%) had an abnormal urinalysis, of whom 319 (3.6%) had a persistent abnormality on retesting. Ultimately, 11 of the children had some form of chronic kidney disease, an incidence of 0.12%.

The authors estimated that the dipstick tests cost $3.47 per patient. According to their calculations, if one case of chronic kidney disease is diagnosed for every 800 screened, the incremental cost-effectiveness ratio is $2779.50 per diagnosed case.

Although the cost seems low, it may be unnecessary altogether, the authors argue, since “it remains unproven that early detection of microscopic hematuria and/or proteinuria… alters the course of a child” who is destined to progress from chronic kidney disease to end-stage renal disease.

Moreover, positive test results lead to more tests with increased costs and anxiety for patients and families, the researchers say.

They would reevaluate their position if early intervention treatments, such as angiotensin-renin blockade, are shown to be effective in children.

Reference:
Pediatrics 2010;125:660-663.