Oxford Kidney Unit, Churchill Hospital, John Radcliffe Hospital, Oxford, UK.
Nephron Clin Pract. 2011;117(4):c348-52. doi: 10.1159/000321515. Epub 2010 Oct 15.
BACKGROUND/AIMS: Guidelines require repeatedly diminished estimated glomerular filtration rate (eGFR) and/or albuminuria to diagnose chronic kidney disease (CKD), and advise screening only in select populations. Many estimates of CKD prevalence have used single measurements. This longitudinal study assessed eGFR and albuminuria reproducibility, and impact on estimate of CKD prevalence, in factory workers.
A total of 512 white workers in a Belarusian industrial factory were initially tested, identifying 206 with abnormal (eGFR <59 ml/min/1.73 m(2) or albuminuria) or near-abnormal (eGFR up to 1 SD above abnormal) renal function. At 3 months, 142 of the abnormal/near-abnormal cohort were re-tested.
Analysis of repeat samples revealed no significant change in eGFR in this population, however 21% individually changed CKD stage. Initial proteinuria was reproducible in only 48% at 3 months. This had a major impact on estimated CKD prevalence: a point prevalence of 8.2% halved with repeat testing. The predictive value of initially abnormal eGFR or albuminuria for repeat abnormality at 3 months was 0.5.
Non-targeted screening for CKD is inaccurate and can overestimate prevalence. This study emphasises the importance of confirming abnormal eGFR and proteinuria on at least one further sample 3 months apart before categorising the individual as having CKD. This has wide implications for screening in European general populations.
背景/目的：指南要求反复检测估算肾小球滤过率（eGFR）和/或白蛋白尿，以诊断慢性肾脏病（CKD），并建议仅在特定人群中进行筛查。许多 CKD 患病率的估计值都使用单次测量值。本纵向研究评估了 eGFR 和白蛋白尿的可重复性，以及其对 CKD 患病率估计值的影响，研究对象为工厂工人。
共有 512 名白俄罗斯工业工厂的白种工人接受了最初的检测，其中 206 人肾功能异常（eGFR<59 ml/min/1.73 m(2)或白蛋白尿）或接近异常（eGFR 比异常高 1 个标准差）。3 个月后，对异常/接近异常队列中的 142 人进行了重新检测。
对重复样本的分析显示，该人群的 eGFR 没有明显变化，但 21%的个体改变了 CKD 分期。只有 48%的人在 3 个月时可重复检测到初始蛋白尿。这对估计 CKD 的患病率有重大影响：重复检测后，点患病率从 8.2%减半。初始异常 eGFR 或白蛋白尿对 3 个月时再次异常的预测值为 0.5。
非目标性 CKD 筛查不准确，可能高估患病率。本研究强调了在将个体归类为 CKD 之前，至少在 3 个月内对另外一份样本进行进一步确认异常 eGFR 和蛋白尿的重要性。这对欧洲一般人群的筛查具有广泛的影响。
