Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Renal, Metabolic, Nutritional, and Endocrine Disorders

Abstract

Background and Objective. Renal, metabolic, nutritional, and endocrine disorders significantly affect Filipinos due to the resulting mortality, cardiovascular outcomes, and negative impact on quality of life. Screening for these disorders may lead to earlier detection and management of the disease, with subsequent improvement of clinical outcomes if early therapeutic options are available. This must be balanced with potential harms resulting from mislabeling and the adverse effects of treatment. The objective of this clinical practice guideline (CPG) is to provide recommendations to optimize patient care on screening for renal, metabolic, nutritional, and endocrine disorders among asymptomatic, apparently healthy Filipinos.

Methods. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended in the Department of Health Manual. The process included 1) generation of critical questions and critical outcomes, 2) retrieval of current evidence, 3) synthesis and assessment of the evidence base for these critical questions, 4) formulation of draft recommendations, 5) convening of a multisectoral stakeholder panel that evaluated the evidence base and considered feasibility, values, and preferences in formulating recommendations, and 6) planning for dissemination, implementation, impact evaluation, and updating. We performed a systematic synthesis of evidence to address screening for high climacteric syndrome, hypocalcemia or hypercalcemia, prediabetes, chronic kidney disease, hyperuricemia, malnutrition, nutritional anemia, among asymptomatic, apparently healthy adult Filipinos, and sexual maturity among asymptomatic, apparently healthy adolescent Filipinos.

Results. After the presentation of the evidence synthesis and deliberation of the consensus panelists, this CPG provides 18 recommendation statements for the eight conditions. These statement recommendations serve as guides for the primary care physicians in their screening  for the identified renal, metabolic, nutritional, and endocrine disorders. The CPG recommends AGAINST screening for high climacteric syndrome among asymptomatic, apparently healthy women aged 45–55 years using hormonal tests. Moreover, the guideline DOES NOT recommend the use of serum calcium, electrocardiogram, or bone mineral density in screening for hypocalcemia or hypercalcemia; estimated glomerular filtration rate, urine albumin concentration, urine albumin-creatinine ratio, and kidney ultrasonography in screening for chronic kidney disease; mid-upper arm circumference in screening for malnutrition; and, serum uric acid in screening for hyperuricemia for apparently healthy, asymptomatic adults. Routine assessment for sexual maturity among asymptomatic adolescents is also NOT recommended. However, the guideline recommends using fasting plasma glucose and hemoglobin A1C in screening for prediabetes and type 2 diabetes mellitus; waist circumference, waist-hip ratio, and body mass index in screening for malnutrition; and hemoglobin and red blood cell parameters in screening for nutritional anemia.

Conclusion. The CPG for the Periodic Health Examination, a joint project of the Department of Health and the National Institutes of Health, addressed selected renal, metabolic, nutritional, and endocrine conditions and provided recommendations for their screening. The statements are made to guide the primary care physicians in the screening of identified renal, metabolic, nutritional, and endocrine disorders. These recommendations will be updated after three years or until new evidence arises.