Clin Nephrol. 2023 Oct;100(4):145-156. doi: 10.5414/CN111106.
Regular monitoring is required to ensure that patients who have, or are at risk of, chronic kidney disease (CKD) receive appropriate management. Guidelines recommend regular testing of estimated glomerular filtration rate (GFR) and albuminuria. However, evidence suggests that albuminuria testing rates, specifically urine albumin-to-creatinine ratio (UACR), are suboptimal.
To assess published evidence relating to the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying CKD across the course of progression.
A systematic review of five bibliographic databases was conducted, supplemented by hand searches of relevant conference abstracts.
One study was identified that reported drivers of non-adherence to albuminuria testing guidelines. The largest barrier was the perception that testing does not impact patient management. Thirteen studies were identified that evaluated the impact of not identifying CKD patients. All included studies analyzed the effect of not identifying worsening CKD severity leading to late referral (LR). 12/13 studies reported only on clinical impact, and 1/13 reported on clinical and economic impact. LR led to higher costs and worse outcomes than early referral, including higher rates of mortality and worsened kidney replacement therapy preparation.
This systematic review demonstrates a gap in evidence exploring the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying patients in the early stages of CKD. Guideline-recommended testing allows timely identification, referral, and treatment for patients with, or at risk of, CKD, providing the best chance of avoiding the worsened outcomes identified in this review.
为确保患有慢性肾脏病（CKD）或有患 CKD 风险的患者得到适当的管理，需要进行定期监测。指南建议定期检测估算肾小球滤过率（GFR）和白蛋白尿。然而，有证据表明，白蛋白尿检测率（特别是尿白蛋白与肌酐比值（UACR））并不理想。
评估与不遵守白蛋白尿检测指南相关的驱动因素以及在疾病进展过程中未识别 CKD 的影响的已发表证据。
对五个文献数据库进行了系统回顾，并补充了相关会议摘要的手工检索。
确定了一项报告不遵守白蛋白尿检测指南的驱动因素的研究。最大的障碍是认为检测不会影响患者的管理。有 13 项研究评估了未识别 CKD 患者的影响。所有纳入的研究都分析了未识别 CKD 严重程度恶化导致延迟转诊（LR）的影响。13 项研究中的 12 项仅报告了临床影响，13 项中的 1 项报告了临床和经济影响。LR 导致的成本更高，结果更差，比早期转诊更差，包括死亡率更高和肾脏替代治疗准备恶化。
本系统评价表明，在探索不遵守白蛋白尿检测指南的驱动因素以及在 CKD 早期未识别患者的影响方面存在证据空白。指南推荐的检测可以及时识别、转诊和治疗患有 CKD 或有患 CKD 风险的患者，为避免本综述中确定的恶化结局提供了最佳机会。
