Although CKD screening programs have been provided in many settings, little is known as to how we can effectively translate those screening programs into improved health.

We conducted a randomized clinical trial on national health screening for CKD in Japan between April 2018 and March 2019. A total of 4011 participants in CKD screening programs aged 40–63 years were randomly assigned to two interventions or the control, with a ratio of 2:2:1, respectively: (1) the nudge-based letter that contained a message on the basis of behavioral economics, (2) the clinical letter including general information about CKD risks, and (3) the control (informed only of the screening results). The main outcome was adherence to a recommended physician visit within 6 months of the intervention. The secondary outcomes were eGFR, proteinuria, and BP 1 year after the intervention.

Compared with the control group, the probability of undergoing a recommended physician visit was higher among participants who received the nudge-based letter (19.7% for the intervention group versus 15.8% for the control; difference, +3.9 percentage points [pp]; 95% CI, +0.8 to +7.0; P=0.02) and the clinical letter (19.7% versus 15.8%; difference, +3.9 pp; 95% CI, +0.8 to +7.0; P=0.02). We found no evidence that interventions were associated with improved early health outcomes.

The behavioral economics intervention tested in this large RCT had limited effect on changing behavior or improving health outcomes. Although the approach has promise, this study demonstrates the challenge of developing behavioral interventions that improve the effectiveness of CKD screening programs.

Clinical Trial registry name and registration number: University Hospital Medical Information Network Clinical Trial Registry, UMIN000035230

尽管在许多环境中都提供了 CKD 筛查计划，但对于我们如何有效地将这些筛查计划转化为改善健康状况知之甚少。

我们于 2018 年 4 月至 2019 年 3 月期间在日本进行了一项关于 CKD 全国健康筛查的随机临床试验。共有 4011 名年龄在 40-63 岁的 CKD 筛查计划参与者被随机分配到两个干预组或对照组，比例为 2 :2:1，分别是：( 1 ) 包含基于行为经济学的信息的基于助推的信函，( 2 ) 临床信函，包括有关 CKD 风险的一般信息，以及 ( 3 ) 控制（仅告知筛选结果）。主要结果是在干预后 6 个月内遵守推荐的医生就诊。次要结果是干预后 1 年的 eGFR、蛋白尿和血压。

与对照组相比，收到推荐信的参与者接受推荐就诊的可能性更高（干预组为 19.7%，对照组为 15.8%；差异，+3.9 个百分点 [pp]；95 % CI，+0.8 至 +7.0；P =0.02）和临床信函（19.7% 对 15.8%；差异，+3.9 pp；95% CI，+0.8 至 +7.0；P =0.02）。我们没有发现任何证据表明干预措施与改善早期健康结果相关。

在此大型随机对照试验中测试的行为经济学干预对改变行为或改善健康结果的作用有限。尽管该方法有希望，但这项研究证明了开发可提高 CKD 筛查计划有效性的行为干预措施的挑战。

临床试验注册中心名称及注册号：大学医院医学信息网临床试验注册中心，UMIN000035230