Clinical application of early screening for chronic kidney disease_West China Medical Journal

Authors：

HUANG Yuxia ¹ , YANG Yuwei ² , TANG Min ¹ , LIU Xiaoli ¹ , SANG Yang ¹ , XU Yizheng ¹ , GUO Li ¹ ,  FENG Jiafu ²

1. Laboratory Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan 610041, P. R. China;
2. Laboratory Medicine, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

FENG Jiafu, Email: jiafufeng@aliyun.com

Keywords：

Chronic kidney disease; Albumin to creatinine ratio; Protein to creatinine ratio; Estimated glomerular filtration rate; Cystatin C

DOI：

10.7507/1002-0179.201811115

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo evaluate the screening performance of commonly used renal function indicators for chronic kidney disease (CKD) in subjects of different ages, so as to explore the appropriate screening regimen for Chinese population.MethodsA total of 2 131 adult subjects in Sichuan Orthopaedic Hospital or Mianyang Central Hospital from May 2016 to October 2017 were selected. They were divided into three groups according to age: group A (18–39 years, n=278), group B (40–64 years, n=1 167), and group C (≥65 years, n=686). Serum levels of creatinine (SCr), urea, and cystatin C [CysC; to calculate estimated glomerular filtration rate (eGFR) based on this index], as well as urine levels of albumin, total protein and creatinine were measured, and urine albumin to creatinine ratio (ACR) and urine protein to creatinine ratio (PCR) were calculated respectively. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) Guideline (2012 Edition). The receiver-operating characteristic (ROC) curve analysis was finally performed to investigate the diagnostic performance of each indicator for CKD.ResultsThe prevalences of CKD in group A, B, and C were 10.8% (30/278), 16.4% (191/1 167), and 45.8% (314/686), respectively, and the difference among these groups was statistically significant (χ²=233.525, P<0.001). In addition, the levels of the six renal function indicators between CKD and non-CKD subjects also had statistically significant differences in different age groups (P<0 05="" otherwise="" roc="" curve="" analysis="" revealed="" that="" the="" diagnostic="" values="" of="" these="" indicators="" were:="" acr="" or="" pcr=""> eGFR or CysC > serum urea or SCr (AllP<0 05="" except="" that="" egfr="" cysc="" serum="" urea="" and="" scr="" in="" group="" a="" assessed="" the="" similar="" diagnostic="" performance="" among="" the="" three="" indicators="" recommended="" by="" kdigo="" guideline="" the="" diagnostic="" performances="" of="" acr="" and="" pcr="" in="" different="" age="" groups="" were:="" group="" b="" 0="" 915="" 0="" 914=""> group A (0.885, 0.890) > group C (0.841, 0.846), while the diagnostic performance of eGFR was group C (0.807) > group B (0.728) > group A (0.696). The best boundary values of ACR and PCR were lower while the value of eGFR was higher than the corresponding KDIGO recommended medical decision levels.ConclusionsACR is the first choice for screening CKD when the renal function index creatinine is normal. Moreover, eGFR can further improve the diagnostic value, especially in subjects over 65 years old.

Citation： HUANG Yuxia, YANG Yuwei, TANG Min, LIU Xiaoli, SANG Yang, XU Yizheng, GUO Li, FENG Jiafu. Clinical application of early screening for chronic kidney disease. West China Medical Journal, 2018, 33(12): 1507-1512. doi: 10.7507/1002-0179.201811115 Copy

1.	Kidney Disease: Improving Global Outcomes (KIDGO) CKD Work Group. KIDGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 2013, 3(1): 1-150.
2.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3.	刘建广, 王新. 随机尿微量白蛋白与肌酐比值对 2 型糖尿病肾病的早期诊断价值. 天津医科大学学报, 2018, 24(3): 224-225.
4.	Papadopoulou‐Marketou N, Chrousos GP, Kanaka‐Gantenbein C. Diabetic nephropathy in type 1 diabetes: a review of early natural history, pathogenesis, and diagnosis. Diabetes Metab Res Rev, 2017, 33(2): e2841.
5.	郑佳成. 分析联合检测胱抑素 C、尿微量白蛋白/肌酐比值、视黄醇结合蛋白在糖尿病早期肾损伤中的临床应用. 世界最新医学信息文摘, 2018(56): 142-146.
6.	Vart P, Scheven L, Lambers Heerspink HJ, et al. Urine albumin-creatinine ratio versus albumin excretion for albuminuria staging: a prospective longitudinal cohort study. Am J Kidney Dis, 2016, 67(1): 70-78.
7.	杨渝伟, 曾平, 张林, 等. 慢性肾病患者基于血清胱抑素 C 与肌酐的肾小球滤过率估算方程的建立和评价. 中华检验医学杂志, 2013, 36(4): 352-359.
8.	李月玲, 白雪梅, 李爱红, 等. 中国 8 个长寿地区老年人肾功能指标检测结果分析. 标记免疫分析与临床, 2017(12): 1328-1330, 1344.
9.	李国福. 前言-关注老年病人肾功能,无处不在. 实用老年医学, 2018(3): 201-217.
10.	罗华丽, 蒋先洪, 文津, 等. 重庆市永川区成人慢性肾脏病流行病学调查. 重庆医学, 2014, 43(29): 3937-3940.
11.	刘晓琳, 周弋, 阮晓楠, 等. 上海市浦东新区慢性肾病流行情况及其危险因素研究. 中国全科医学, 2016, 19(30): 3742-3750.
12.	Tsai MH, Hsu CY, Lin MY, et al. Incidence, prevalence, and duration of chronic kidney disease in Taiwan: results from a community-based screening program of 106,094 individuals. Nephron, 2018, 140(3): 175-184.
13.	刘聪慧, 陈海平. 慢性肾病 3 期诊断标准对老年人群的适用性. 中华保健医学杂志, 2013, 15(2): 199-201.
14.	Wang HB, Li R, Liu R, et al. Second morning ACR could be the alternative to first morning ACR to assess albuminuria in elderly population. J Clin Lab Anal, 2016, 30(2): 175-179.
15.	Kim KS, Park SW, Cho YW, et al. Higher prevalence and progression rate of chronic kidney disease in elderly patients with type 2 diabetes mellitus. Diabetes Metab J, 2018, 42(3): 224-232.

1. Kidney Disease: Improving Global Outcomes (KIDGO) CKD Work Group. KIDGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 2013, 3(1): 1-150.
2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3. 刘建广, 王新. 随机尿微量白蛋白与肌酐比值对 2 型糖尿病肾病的早期诊断价值. 天津医科大学学报, 2018, 24(3): 224-225.
4. Papadopoulou‐Marketou N, Chrousos GP, Kanaka‐Gantenbein C. Diabetic nephropathy in type 1 diabetes: a review of early natural history, pathogenesis, and diagnosis. Diabetes Metab Res Rev, 2017, 33(2): e2841.
5. 郑佳成. 分析联合检测胱抑素 C、尿微量白蛋白/肌酐比值、视黄醇结合蛋白在糖尿病早期肾损伤中的临床应用. 世界最新医学信息文摘, 2018(56): 142-146.
6. Vart P, Scheven L, Lambers Heerspink HJ, et al. Urine albumin-creatinine ratio versus albumin excretion for albuminuria staging: a prospective longitudinal cohort study. Am J Kidney Dis, 2016, 67(1): 70-78.
7. 杨渝伟, 曾平, 张林, 等. 慢性肾病患者基于血清胱抑素 C 与肌酐的肾小球滤过率估算方程的建立和评价. 中华检验医学杂志, 2013, 36(4): 352-359.
8. 李月玲, 白雪梅, 李爱红, 等. 中国 8 个长寿地区老年人肾功能指标检测结果分析. 标记免疫分析与临床, 2017(12): 1328-1330, 1344.
9. 李国福. 前言-关注老年病人肾功能,无处不在. 实用老年医学, 2018(3): 201-217.
10. 罗华丽, 蒋先洪, 文津, 等. 重庆市永川区成人慢性肾脏病流行病学调查. 重庆医学, 2014, 43(29): 3937-3940.
11. 刘晓琳, 周弋, 阮晓楠, 等. 上海市浦东新区慢性肾病流行情况及其危险因素研究. 中国全科医学, 2016, 19(30): 3742-3750.
12. Tsai MH, Hsu CY, Lin MY, et al. Incidence, prevalence, and duration of chronic kidney disease in Taiwan: results from a community-based screening program of 106,094 individuals. Nephron, 2018, 140(3): 175-184.
13. 刘聪慧, 陈海平. 慢性肾病 3 期诊断标准对老年人群的适用性. 中华保健医学杂志, 2013, 15(2): 199-201.
14. Wang HB, Li R, Liu R, et al. Second morning ACR could be the alternative to first morning ACR to assess albuminuria in elderly population. J Clin Lab Anal, 2016, 30(2): 175-179.
15. Kim KS, Park SW, Cho YW, et al. Higher prevalence and progression rate of chronic kidney disease in elderly patients with type 2 diabetes mellitus. Diabetes Metab J, 2018, 42(3): 224-232.

West China Medical Journal

Clinical application of early screening for chronic kidney disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content