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  Cochrane Databaseof SystematicReviews Screeningwithurinarydipsticksforreducingmorbidityandmortality(Review) Krogsbøll LT, Jørgensen KJ, Gøtzsche PC KrogsbøllLT, Jørgensen KJ, Gøtzsche PC.Screening withurinary dipsticks for reducing morbidity and mortality. CochraneDatabaseofSystematicReviews  2015, Issue1. Art. No.: CD010007.DOI: 10.1002/14651858.CD010007.pub2. www.cochranelibrary.com Screening withurinary dipsticksforreducing morbidityand mortality(Review) Copyright ©2015The CochraneCollaboration. Published byJohn Wiley& Sons,Ltd.  T A B L E O F C O N T E N T S 1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23FEEDBACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iScreening with urinary dipsticks for reducing morbidity and mortality (Review)Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.  [Intervention Review] Screening with urinary dipsticks for reducing morbidity andmortality Lasse T Krogsbøll 1 , Karsten Juhl Jørgensen 1 , Peter C Gøtzsche 11 The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark Contactaddress: Lasse TKrogsbøll,TheNordicCochrane Centre,Rigshospitalet, Blegdamsvej 9,7811, Copenhagen, 2100, Denmark.ltk@cochrane.dk , l.t.krogsboll@gmail.com. Editorial group:  Cochrane Kidney and Transplant Group. Publication status and date:  New, published in Issue 1, 2015. Citation:  Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. Screening with urinary dipsticks for reducing morbidity and mortality.  Cochrane Database of Systematic Reviews   2015, Issue 1. Art. No.: CD010007. DOI: 10.1002/14651858.CD010007.pub2.Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. A B S T R A C T Background  Urinary dipsticks are sometimes used for screening asymptomatic people, and for case-finding among inpatients or outpatients whodo not have genitourinary symptoms. Abnormalities identified on screening sometimes lead to additional investigations, which may identify serious disease, such as bladder cancer and chronic kidney disease (CKD). Urinary dipstick screening could improve prognosesdue to earlier detection, but could also lead to unnecessary and potentially invasive follow-up testing and unnecessary treatment. Objectives  We aimed to quantify the benefits and harms of screening with urinary dipsticks in general populations and patients in hospitals. Search methods  WesearchedtheCochrane RenalGroup’sSpecialisedRegister to8September2014 throughcontactwiththeTrialsSearchCo-ordinatorusing search terms relevant to this review. Selection criteria  Randomised controlled trials and other study types that compared urinary dipstick screening with no dipstick screening were eligiblefor inclusion. We searched for studies that investigated the use of urinary dipsticks for detecting haemoglobin, protein, albumin,albumin-creatinine ratio, leukocytes, nitrite, or glucose, alone or in any combination, and in any setting. We planned toexclude studiesconducted in patients with urinary disorders. Data collection and analysis It was planned that two authors would independently extract data from included studies and assess risk of bias using the Cochrane risk of bias tool. However, no studies met our inclusion criteria. Main results Literature searches to 8 September 2014 yielded 4298 records, of which 4249 were excluded following title and abstract assessment.There were 49 records (44 studies) eligible for full text assessment; of these 18 studies were not RCTs and 26 studies comparedinterventions or controls that were not relevant to this review. Thus, no studies were eligible for inclusion. 1Screening with urinary dipsticks for reducing morbidity and mortality (Review)Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.   Authors’ conclusions  We found no evidence to assess the benefits and harms of screening with urinary dipsticks, which remain unknown. P L A I N L A N G U A G E S U M M A R Y Screening with urinary dipsticks for reducing morbidity and mortality  Urinary dipsticks are sometimes used for screening healthy people and patients that do not have symptoms of urinary disease. Urinary dipsticks can be used to test for several different substances, such as blood, sugar, protein, white blood cells and nitrite in the urine, which may indicate the presence of disease. Identified abnormalities sometimes lead to additional investigations, which may identify serious disease, such as bladder cancer and chronic kidney disease. Detection could improve health outcomes from finding disease atearlier stages, but could also lead to unnecessary follow-up testing, which may be invasive, and lead to unnecessary treatment. We searched the literature to September 2014 to identify studies that compared urinary dipstick screening with no dipstick screening.However, we found no studies that met our inclusion criteria. We were unable to determine benefits and harms associated with urinary dipstick screening. B A C K G R O U N D Urinary dipsticktestingiswidelyusedtoscreenforthepresenceof disease with the aim of reducing morbidity and mortality in bothhealthy people and patients (Grønhøj Larsen 2010; Merenstein 2006; Prochazka 2005). Dipsticks can test for either single or multiple substances in urine, and are sometimes used in generalhealth checks.Urinarydipsticktestingisrecommendedforscreeningpeoplewithdiabetes to detect a specific protein (albumin) in the urine (albu-minuria) (NICE 2008b). Another potential screening populationispeoplewithhighbloodpressure(hypertension).Atpresent,thereis alackof consensus on theserecommendations, and most guide-lines recommend use of albumin-creatinine or protein-creatinineratios rather than dipsticks to detect proteinuria or albuminuria.However, dipsticks are less expensive than these tests and dipstick proteinuriaisstronglyrelatedtototalandcardiovascular mortality (CKDPC 2010). Screening with urine culture is recommendedfor pregnant women to detect bacteria in the urine (bacteriuria) (Lin 2008; NICE 2008a ). Since the 1970s, school children and employed adults in Japanhavebeenofferedurinarydipstickscreeningforbloodandprotein;from 1983, this was extended to all adults aged 40 years and over(Imai 2007). Taiwan implemented dipstick screening for childrenin 1990, and Korea in 1998 (Hogg 2009).There appear to be no recommendations for population-basedscreening with urinary dipsticks, and the scientific debate persistsabout screening for CKDwith othermethods(Brown 2011). Op-portunistic screening is often recommended, but only for highrisk groups (Krogsbøll 2014). A systematic review of screening for CKD with any method found no randomised controlled trials(RCTs) and concluded that the role of screening was uncertain(Fink 2012).There is, however, discrepancy between recommendations andpractice. Ease of use, low cost, and the perceived test safety may contribute to this discrepancy. Although screening can work (Holme 2013; Raffle 2003; Thomason 1998), it is noteworthy  thatexperiencewithotherscreeninginterventionsfordiseasessuchas prostate cancer (Djulbegovic 2010), breast cancer (Gøtzsche 2013), and neuroblastoma (Schilling 2002; Woods 2002) have indicated that screening benefits can be less than expected, andthat screening can cause more harm than good.Dipstick testing is routinely used for case-finding among people with conditions that increase the risk of kidney disease, such asdiabetes and hypertension. Both have wide spectrums of severity,do not often cause symptoms, and encompass a large proportionof adults. Definitions for these conditions are derived throughconsensus, and have been the subject of debate as they have beenbroadened over time. Thus, case-finding in such broad categoriesborders on screening, but RCTs are unlikely to be performed andthe question must therefore be informed by detailed analysis of observational studies, which is outside the scope of this review. 2Screening with urinary dipsticks for reducing morbidity and mortality (Review)Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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