Gama Rouvick Mariano, Nebres Danilo, Bramham Kate
Department of Inflammation Biology, Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, Sir James Black Centre, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.
King's Kidney Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Diagnostics (Basel). 2024 Jul 17;14(14):1542. doi: 10.3390/diagnostics14141542.
Chronic kidney disease (CKD) poses a significant global health challenge with increasing prevalence and associated morbidity. Point-of-care testing (POCT) provides an opportunity to improve CKD management and outcomes through early detection and targeted interventions, particularly in underserved communities. This review evaluates the roles of POCT in CKD, focusing on utility (through screening programs, monitoring of kidney function, and assessing participants on renally excreted medications), accuracy, and acceptability. Screening programs employing POCT have demonstrated promising outcomes, with improved rates of CKD diagnosis in groups with disparate health outcomes, offering a vital avenue for early intervention in high-risk populations. These have been conducted in rural and urban community or pharmacy settings, highlighting convenience and accessibility as important facilitators for participants. In addition, POCT holds significant promise in the monitoring of CKD, particularly in groups requiring frequent testing, such as kidney transplant recipients and patients on renin-angiotensin-aldosterone inhibitors. The consideration of the variable analytical performance of different devices remains crucial in assessing the utility of a POCT intervention for CKD. While the convenience and improved accessibility of home self-testing versus healthcare professional management is important, it must be balanced with acceptable levels of accuracy and precision to maintain patient and clinical confidence. Despite challenges including variability in accuracy and the user-friendliness of devices, patient feedback has generally remained positive, with studies reporting increased patient satisfaction and engagement. However, challenges regarding wider uptake are limited by healthcare professional confidence (in test reliability), the potential for increased workload, and early prohibitive costs. In conclusion, POCT represents a growing and valuable tool in enhancing CKD care, particularly in resource-limited settings, but careful consideration of device selection and implementation strategies is essential to achieve desired outcomes.
慢性肾脏病（CKD）患病率不断上升且相关发病率增加，对全球健康构成重大挑战。即时检验（POCT）为改善CKD管理及预后提供了契机，可通过早期检测和针对性干预实现，尤其在医疗服务不足的社区。本综述评估了POCT在CKD中的作用，重点关注其效用（通过筛查项目、肾功能监测以及评估肾排泄药物的参与者）、准确性和可接受性。采用POCT的筛查项目已显示出有前景的结果，在健康结局不同的群体中CKD诊断率有所提高，为高危人群的早期干预提供了重要途径。这些筛查项目已在农村和城市社区或药房环境中开展，凸显了便利性和可及性对参与者的重要促进作用。此外，POCT在CKD监测方面具有巨大潜力，特别是在需要频繁检测的群体中，如肾移植受者和使用肾素 - 血管紧张素 - 醛固酮抑制剂的患者。在评估POCT干预对CKD的效用时，考虑不同设备的可变分析性能仍然至关重要。虽然家庭自测相对于医疗专业人员管理的便利性和可及性有所提高很重要，但必须与可接受的准确度和精密度水平相平衡，以维持患者和临床的信心。尽管存在包括准确性差异和设备用户友好性等挑战，但患者反馈总体上仍然积极，研究报告患者满意度和参与度有所提高。然而，更广泛采用面临的挑战受到医疗专业人员信心（对检测可靠性）、工作量增加的可能性以及早期高昂成本的限制。总之，POCT是增强CKD护理的一种日益重要且有价值的工具，特别是在资源有限的环境中，但仔细考虑设备选择和实施策略对于实现预期结果至关重要。
