Keshvari-Shad Fatemeh, Hajebrahimi Sakineh, Pilar Laguna Pes Maria, Mahboub-Ahari Alireza, Nouri Mohammad, Seyednejad Farshad, Yousefi Mahmood
Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sceinecs, Tabriz, Iran.
Research Center for Evidence Based Medicine, Faculty of Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran.
Galen Med J. 2020 Jun 22;9:e1573. doi: 10.31661/gmj.v9i0.1573. eCollection 2020.
This systematic review was conducted to assess the diagnostic accuracy of chronic kidney disease screening tests in the general population. MEDLINE, EMBASE, Web of Science, Scopus, The Cochrane Library and ProQuest databases were searched for English-language publications up to November 2016. Two reviewers independently screened studies and extracted study data in standardized tables. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of all available screening methods were identified through included studies. Ten out of 1349 screened records included for final analysis. Sensitivities of the dipstick test with a cutoff value of trace were ranged from 37.1% to 69.4% and specificities from 93.7% to 97.3% for the detection of ACR>30 mg/g. The diagnostic sensitivities of the UAC>10 mg/dL testing was shown to vary from 40% to 87%, and specificities ranged from 75% to 96%. While the sensitivities of ACR were fluctuating between 74% and 90%, likewise the specificities were between 77% and 88%. Sensitivities for C-G, Grubb and Larsson equations were 98.9%, 86.2%, and 70.1% respectively. In the meantime the study showed specificities of 84.8%, 84.2% and 90.5% respectively for these equations. Individual studies were highly heterogeneous in terms of target populations, type of screening tests, thresholds used to detect CKD and variations in design. Results pointed to the superiority of UAC and dipstick over the other tests in terms of all parameters involved. The diversity of methods and thresholds for detection of CKD, necessitate considering the cost parameter along with the effectiveness of tests to scale-up an efficient strategy.
本系统评价旨在评估普通人群中慢性肾脏病筛查试验的诊断准确性。检索了MEDLINE、EMBASE、Web of Science、Scopus、Cochrane图书馆和ProQuest数据库，以查找截至2016年11月的英文出版物。两名评价者独立筛选研究并在标准化表格中提取研究数据。使用QUADAS-2工具评估方法学质量。通过纳入的研究确定所有可用筛查方法的敏感性和特异性。1349条筛选记录中有10条纳入最终分析。检测ACR>30 mg/g时，以微量为临界值的试纸条试验敏感性范围为37.1%至69.4%，特异性范围为93.7%至97.3%。UAC>10 mg/dL检测的诊断敏感性显示在40%至87%之间变化，特异性范围为75%至96%。虽然ACR的敏感性在74%至90%之间波动，同样特异性在77%至88%之间。C-G、格鲁布和拉尔森方程的敏感性分别为98.9%、86.2%和70.1%。同时，该研究显示这些方程的特异性分别为84.8%·、84.2%和90.5%。个体研究在目标人群、筛查试验类型、用于检测CKD的阈值和设计变化方面高度异质性。结果表明，就所有涉及的参数而言，UAC和试纸条试验优于其他试验。检测CKD的方法和阈值的多样性，需要在扩大有效策略时考虑成本参数以及试验的有效性。
