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

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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.	劉建廣, 王新. 隨機尿微量白蛋白與肌酐比值對 2 型糖尿病腎病的早期診斷價值. 天津醫科大學學報, 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.	鄭佳成. 分析聯合檢測胱抑素 C、尿微量白蛋白/肌酐比值、視黃醇結合蛋白在糖尿病早期腎損傷中的臨床應用. 世界最新醫學信息文摘, 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.	楊渝偉, 曾平, 張林, 等. 慢性腎病患者基于血清胱抑素 C 與肌酐的腎小球濾過率估算方程的建立和評價. 中華檢驗醫學雜志, 2013, 36(4): 352-359.
8.	李月玲, 白雪梅, 李愛紅, 等. 中國 8 個長壽地區老年人腎功能指標檢測結果分析. 標記免疫分析與臨床, 2017(12): 1328-1330, 1344.
9.	李國福. 前言-關注老年病人腎功能,無處不在. 實用老年醫學, 2018(3): 201-217.
10.	羅華麗, 蔣先洪, 文津, 等. 重慶市永川區成人慢性腎臟病流行病學調查. 重慶醫學, 2014, 43(29): 3937-3940.
11.	劉曉琳, 周弋, 阮曉楠, 等. 上海市浦東新區慢性腎病流行情況及其危險因素研究. 中國全科醫學, 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.	劉聰慧, 陳海平. 慢性腎病 3 期診斷標準對老年人群的適用性. 中華保健醫學雜志, 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. 劉建廣, 王新. 隨機尿微量白蛋白與肌酐比值對 2 型糖尿病腎病的早期診斷價值. 天津醫科大學學報, 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. 鄭佳成. 分析聯合檢測胱抑素 C、尿微量白蛋白/肌酐比值、視黃醇結合蛋白在糖尿病早期腎損傷中的臨床應用. 世界最新醫學信息文摘, 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. 楊渝偉, 曾平, 張林, 等. 慢性腎病患者基于血清胱抑素 C 與肌酐的腎小球濾過率估算方程的建立和評價. 中華檢驗醫學雜志, 2013, 36(4): 352-359.
8. 李月玲, 白雪梅, 李愛紅, 等. 中國 8 個長壽地區老年人腎功能指標檢測結果分析. 標記免疫分析與臨床, 2017(12): 1328-1330, 1344.
9. 李國福. 前言-關注老年病人腎功能,無處不在. 實用老年醫學, 2018(3): 201-217.
10. 羅華麗, 蔣先洪, 文津, 等. 重慶市永川區成人慢性腎臟病流行病學調查. 重慶醫學, 2014, 43(29): 3937-3940.
11. 劉曉琳, 周弋, 阮曉楠, 等. 上海市浦東新區慢性腎病流行情況及其危險因素研究. 中國全科醫學, 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. 劉聰慧, 陳海平. 慢性腎病 3 期診斷標準對老年人群的適用性. 中華保健醫學雜志, 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

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