Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Am J Kidney Dis. 2021 Jul;78(1):57-65.e1. doi: 10.1053/j.ajkd.2020.10.019. Epub 2020 Dec 22.
RATIONALE & OBJECTIVE: Screening for chronic kidney disease (CKD) is recommended for patients with diabetes and hypertension as stated by the respective professional societies. However, CKD, a silent disease usually detected at later stages, is associated with low socioeconomic status (SES). We assessed whether adding census tract SES status to the standard screening approach improves our ability to identify patients with CKD.
Screening test analysis.
SETTINGS & PARTICIPANTS: Electronic health records (EHR) of 256,162 patients seen at a health care system in the 7-county Minneapolis/St. Paul area and linked census tract data.
The first quartile of census tract SES (median value of owner-occupied housing units <$165,200; average household income <$35,935; percentage of residents >25 years of age with a bachelor's degree or higher <20.4%), hypertension, and diabetes.
CKD (eGFR <60 mL/min/1.73 m, or urinary albumin-creatinine ratio >30mg/g, or urinary protein-creatinine ratio >150mg/g, or urinary analysis [albuminuria] >30 mg/d).
Sensitivity, specificity, and number needed to screen (NNS) to detect CKD if we screened patients who had hypertension and/or diabetes and/or who lived in low-SES tracts (belonging to the first quartile of any of the 3 measures of tract SES) versus the standard approach.
CKD was prevalent in 13% of our cohort. Sensitivity, specificity, and NNS of detecting CKD after adding tract SES to the screening approach were 67% (95% CI, 66.2%-67.2%), 61% (95% CI, 61.1%-61.5%), and 5, respectively. With the standard approach, sensitivity of detecting CKD was 60% (95% CI, 59.4%-60.4%), specificity was 73% (95% CI, 72.4%-72.7%), and NNS was 4.
One health care system and selection bias.
Leveraging patients' addresses from the EHR and adding tract-level SES to the standard screening approach modestly increases the sensitivity of detecting patients with CKD at a cost of decreased specificity. Identifying further factors that improve CKD detection at an early stage are needed to slow the progression of CKD and prevent cardiovascular complications.
专业协会建议对患有糖尿病和高血压的患者进行慢性肾脏病（CKD）筛查。然而，CKD 是一种通常在后期才被发现的隐匿性疾病，与较低的社会经济地位（SES）有关。我们评估了在标准筛查方法中加入普查区 SES 状况是否可以提高我们识别 CKD 患者的能力。
筛查试验分析。
明尼阿波利斯/圣保罗地区 7 个县的医疗保健系统中 256162 名患者的电子健康记录（EHR），并链接普查区数据。
普查区 SES 的第一个四分位数（自住房屋单元中位数价值<$165200；家庭平均收入<$35935；25 岁及以上居民中拥有学士或更高学历的比例<$20.4%）、高血压和糖尿病。
CKD（估算肾小球滤过率[eGFR]＜60mL/min/1.73m2，或尿白蛋白-肌酐比值＞30mg/g，或尿蛋白-肌酐比值＞150mg/g，或尿分析[蛋白尿]＞30mg/d）。
敏感性、特异性和 NNS（如果我们筛查患有高血压和/或糖尿病且/或居住在 SES 较低的普查区（属于任何 3 项普查区 SES 措施的第一四分位数）的患者，而不是标准方法）以检测 CKD。
我们队列中有 13%的患者患有 CKD。在筛查方法中加入 SES 后，检测 CKD 的敏感性、特异性和 NNS 分别为 67%（95%CI，66.2%-67.2%）、61%（95%CI，61.1%-61.5%）和 5。使用标准方法，检测 CKD 的敏感性为 60%（95%CI，59.4%-60.4%），特异性为 73%（95%CI，72.4%-72.7%），NNS 为 4。
单一医疗保健系统和选择偏倚。
利用 EHR 中的患者地址，并将 SES 纳入标准筛查方法，可适度提高检测 CKD 患者的敏感性，但特异性降低。需要确定进一步改善早期 CKD 检测的因素，以减缓 CKD 的进展并预防心血管并发症。
