Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
J Am Soc Nephrol. 2011 Sep;22(9):1729-36. doi: 10.1681/ASN.2010111217. Epub 2011 Aug 1.
Rapid kidney function decline (RKFD) predicts cardiovascular morbidity and mortality, but serial assessment of estimated GFR (eGFR) is not cost-effective for the general population. Here, we evaluated the predictive value of albuminuria and three thresholds of dipstick proteinuria to identify RKFD in 2,574 participants in a community-based prospective cohort study with a median of 7 years follow-up. Median change in eGFR was -0.78 ml/min per 1.73 m(2) per year; with 8.5% experiencing RKFD, defined as a >5% annual eGFR decline from baseline. Of those with RKFD, 65% advanced to a new CKD stage compared with 19% of those without RKFD. Dipstick protein ≥ 1 g/L was a stronger predictor of RKFD than albuminuria. Overall, 2.5% screened positive for dipstick protein ≥ 1 g/L at baseline; one of every 2.6 patients would have RKFD if all were followed with serial eGFR measurement. Overall, the screening strategy correctly identified progression status for 90.8% of patients, mislabeled 1.5% as RKFD, and missed 7.7% with eventual RKFD. Among those with risk factors (cardiovascular disease, age >60, diabetes, or hypertension), the probability of identifying RKFD from serial eGFR measurements increased from 13 to 44% after incorporating dipstick protein (≥ 1 g/L threshold). In summary, inexpensive screening with urine dipstick should allow primary care physicians to follow fewer patients with serial eGFR assessment but still identify those with rapid decline of kidney function.
肾功能快速下降（RKFD）可预测心血管发病率和死亡率，但对普通人群进行估计肾小球滤过率（eGFR）的连续评估并不具有成本效益。在这里，我们评估了蛋白尿和三种尿蛋白试纸检测阈值在预测 2574 名社区为基础的前瞻性队列研究参与者中的价值，该研究的中位随访时间为 7 年。eGFR 的中位数变化为 -0.78 ml/min per 1.73 m(2) per year；8.5%的患者发生 RKFD，定义为基线时 eGFR 每年下降>5%。在发生 RKFD 的患者中，有 65%的患者进展到新的 CKD 阶段，而未发生 RKFD 的患者中这一比例为 19%。尿蛋白试纸检测蛋白≥1g/L 比白蛋白尿更能预测 RKFD。总体而言，2.5%的患者在基线时尿蛋白试纸检测蛋白阳性≥1g/L；如果所有患者都接受连续 eGFR 测量，每 2.6 例患者中就有 1 例会发生 RKFD。总的来说，该筛查策略正确识别了 90.8%的患者的进展状态，1.5%的患者被错误地标记为 RKFD，7.7%的患者最终出现 RKFD，但未被发现。在有危险因素（心血管疾病、年龄>60 岁、糖尿病或高血压）的患者中，在纳入尿蛋白试纸检测结果（≥1g/L 阈值）后，从连续 eGFR 测量中识别 RKFD 的概率从 13%增加到 44%。总之，通过尿蛋白试纸进行廉价的筛查可以让初级保健医生减少对连续 eGFR 评估的患者数量，但仍能识别出那些肾功能快速下降的患者。
