Combination Test Often Predicts ESRD

Photo: Arteries with the kidneys behind imaged

Which kidney disease might
become worse than the other - a
double test can show it; © SXC

This combination test could help physicians identify patients at high risk of serious kidney trouble and allow them to intervene at an early stage. The factors to measure are the glomerular filtration rate (GFR) and the urinary albumin levels.

While there is a high prevalence of CKD worldwide, relatively few individuals with the disease develop ESRD, expected to affect 785,000 people in the U.S. by 2020. Physicians and researchers have looked for ways to identify which patients will progress to ESRD in order to target patients most in need of extensive treatment, and help establish clinical guidelines and public health plans for treating patients with CKD.

Stein Hallan and his colleagues recently conducted a study to see if combining two tests commonly used to measure kidney function might help predict ESRD. One test measures an individual’s estimated glomerular filtration rate (eGFR - a measure of the volume of fluid filtered by the kidneys), while the other measures the amount of albumin (the predominant protein in the blood) that is excreted in urine. A high urinary albumin level indicates a rapid rate of kidney disease progression, and a low eGFR indicates an advanced stage of disease.

The researchers analysed data from 65,589 adults and found 124 individuals who developed ESRD after more than ten years of follow-up. Combining urinary albumin and eGFRs results identified more than 65 percent of patients who would develop this condition. Other factors such as hypertension, diabetes, smoking, obesity, and cardiovascular disease did not provide any additional information that could be used to predict who would develop ESRD.

“We provide clear evidence that reduced eGFR should always be complemented by information on urine-albumin to yield optimal prediction of the risk of progression to ESRD,” said Hallan. He added that combining these measurements might also help reduce the number of patients referred to specialists without losing the ability to detect future ESRD cases.

“Future risk scores and classification systems based on these two variables will be a simple and powerful tool for improving our ability to efficiently handle the large group of patients with CKD,” the authors wrote.

MEDICA.de; Source: American Society of Nephrology (ASN)