Rationale of screening for early kidney damage in patients with high cardiovascular risk: nephrologist’s point of view

Open access


Increased awareness of chronic kidney disease stimulates an interest towards early detection and prevention. The true prevalence of kidney injury varies from 10 to 40%, mostly depending on the methodology of the study and the population enrolled. A screening strategy targeting the highest risk groups, those with diabetes or hypertension, family history of diabetes, hypertension, or kidney disease, is likely to be most efficient and cost effective. Quantification for albuminuria should be performed using laboratorymethods or albumin to creatinine ratio and should be monitored at regular intervals. The most correct equations calculating glomerular filtration rate differ in separate populations, and the most accurate equations in patients with high cardiovascular risk are MDRD and CKD-EPI. Markers of early kidney damage have association with other target organs damage, even in subclinical or preclinical mode. Individuals at stage 4 and 5 chronic kidney disease, with higher levels of proteinuria, proteinuria together with haematuria, rapidly declining glomerular filtration rate, or poorly controlled hypertension should be referred to a nephrologist in order to identify the cause, provide recommendations, slow progression, or treat complications.

[1] MacGregor MS. How common is early chronic kidney disease? A background paper prepared for the UK consensus conference on early chronic kidney disease. Nephrol DialTransplant 2007; 22(suppl 9):ix8-ix18.

[2] Anderson S, Halter JB, HazzardWR, Himmelfarb J, Horne FM, Kaysen GA et al. Prediction, progression, and outcomes of chronic kidney disease in older adults. J Am SocNephrol 2009; 20:1199-1209.

[3] Department of Health. The national service framework for renal services. Part two: chronic kidney disease, acute renal failure and end of life care. COI: London, 2005.

[4] Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67:2089-2100.

[5] Toussaint N. Screening for early kidney disease. The CARI guidelines. Published online, 2011, http://www.cari.org.au/DNT%20workshop%202011/4%20Screening_Early%20CKD_DNT.pdf.

[6] Vassalotti JA, Li S, Chen SC, Collins AJ. Screening populations at increased risk of CKD: The Kidney Early Evaluation Program (KEEP) and the public health problem. AmJ Kidney Dis 2009; 53:S107-S114.

[7] Ishani A, Grandits GA, Grimm RH, Svendsen KH, Collins AJ, Prineas RJ et al. Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial. J AmSoc Nephrol 2006; 17:1444-1452.

[8] Kidney Disease Outcomes Quality Initiative. Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002; 39(Suppl 1):S46-S75.

[9] Shafi T, Coresh J. Definition and classification of stages of chronic kidney disease: screening for chronic kidney disease. Cardiorenal syndrome. Springer, 2010.

[10] Mariat C, Maillard N, Phayphet M, Thibaudin L, Laporte S, Alamartine E et al. Estimated glomerular filtration rate as an end point in kidney transplant trial: where do we stand? Nephrol Dial Transplant 2008; 23:33-38.

[11] Jones GR, Lim EM. The National Kidney Foundation guideline on estimation of the glomerular filtration rate. Clin Biochem Rev 2003; 24:95-98.

[12] Rule A. The CKD-EPI equation for estimating GFR from serum creatinine: real improvement ormore of the same? CJASN 2010; 5:951-953.

[13] Nyman H, Dowling T, Hudson J, Wendy L, Joy M, Nolin TD. Use of the Cockcroft-Gault versus the MDRD study equation to dose medications: an opinion of the nephrology practice and research network of the American College of clinical pharmacy. Pharmacotherapy 2011; 31:1130-1144.

[14] Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R et al. comparison of drug dosing recommendations based onmeasured GFR and kidney function estimating equations. AJKD 2009; 54:33-42.

[15] Vervoort G, Willems H, Wetzels J. Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation. Nephrol Dial Transplant 2002; 17:1909-1913.

[16] Delanaye P, Cavalier E, Mariat C, Mailard N, Krzesinski JM. MDRD or CKD-EPI study equations for estimating prevalence of stage 3 CKD in epidemiological studies: which difference? Is this difference relevant? BMCNephrology 2010; 11:8.

[17] Delanaye P, Cohen E. Formula-based estimates of the GFR: equations variable and uncertain. Nephron Clin Pract 2008; 110:c48-c54.

[18] Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150:604-612.

[19] Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD Study equation for estimated glomerular filtration rate. JAMA 2012; 307:1941-1951.

[20] Kilbride HS, Stevens PE, Eaglestone G, Knight S, Carter JL, Delaney MP et al. Accuracy of the MDRD (Modification of Diet in Renal Disease) study and CKD-EPI (CKD Epidemiology Collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis 2013; 61:57-66.

[21] Pugliese G, Solini A, Bonora E, Orsi E, Zerbini G, Giorgino F et al. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation provides a better definition of cardiovascular burden associated with CKD than the Modification of Diet in Renal Disease (MDRD) study formula in subjects with type 2 diabetes. Atherosclerosis 2011; 218:194-199.

[22] Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ et al. Current issues in measurementand reporting of urinary albumin excretion. Clin Chem 2009; 55:24-38.

[23] MillerWG, Bruns DE. Laboratory issues in measuring and reporting urine albumin. Nephrol Dial Transplant 2009; 24:717-718.

[24] Mura-Galelli MJ, Voegel JC, Behr S, Bres EF, Schaaf P. Adsorption/desorption of human serum albumin on hydroxyapatite: a critical analysis of the Langmuir model. Proc Natl Acad Sci USA 1991; 88:5557-5561.

[25] Comper WD, Osicka TM. Detection of urinary albumin. Adv Chronic Kidney Dis 2005; 12:170-176.

[26] Methven S, MacGregor MS, Traynor JP, O‘Reilly DS, Deighan CJ. Assessing proteinuria in chronic kidney disease: protein-creatinine ratio versus albumin-creatinine ratio. Nephrol Dial Transplant 2010; 25:2991-2996.

[27] Comper WD, Jerums G, Osicka TM. Differences in urinary albumin detected by four immunoassays and high-performance liquid chromatography. Clin Biochem 2004; 37:105.

[28] Shaikh A, Seegmiller JC, Borland TM, Burns BE, Ladwig PM, Singh RJ et al. Comparison between immunoturbidimetry, size-exclusion chromatography, and LC-MS to quantify urinary albumin. Clin Chem 2008; 54:1504-1510.

[29] McQueen MJ, Gerstein HC, Pogue J, Mann JF, Yusuf S. Reevaluation by high performance liquid chromatography: clinical significance of microalbuminuria in individuals at high risk of cardiovascular disease in the Heart Outcomes Prevention Evaluation (HOPE) study. Am J Kidney Dis 2006; 48:889-896.

[30] Clase CM, St Pierre MW, Churchill DN. Conversion between bromcresol green- and bromcresol purplemeasured albumin in renal disease. Nephrol Dial Transplant 2001; 16:1925-1929.

[31] Pedrinelli R, Penno G, Dell‘Omo G, Bandinelli S, Giorgi D, Di Bello V et al. Microalbuminuria and transcapillary albumin leakage in essential hypertension. Hypertension 1999; 34:491-495.

[32] Chen YH, Chen HS, Tarng DC. More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients. Diabetes Care 2012; 35:803-808.

[33] Berni A, Ciani E, Bernetti M, Cecioni I, Berardino S, Poggesi L et al. Renal resistive index and low-grade inflammation in patients with essential hypertension. J HumHypertens 2012; 26:723-730.

[34] Umemura T, Kawamura T, Sakakibara T, Mashita S, Hotta N, Sobue G. Microalbuminuria is independently associated with deep or infratentorial brain microbleeds in hypertensive adults. Am J Hypertens 2012; 25:430-436.

[35] Sierra C, Lopez-Soto A, Coca A. Connecting cerebral white matter lesions and hypertensive target organ damage. J Aging Res 2011; 2011:438978.

[36] Jørgensen L, Jenssen T, Johnsen SH, Mathiesen EB, Heuch I, Joakimsen O et al. Albuminuria as risk factor for initiation and progression of carotid atherosclerosis in non-diabetic persons: the Tromsø Study. Eur Heart 2007; 28:363-369.

[37] Joosten H, Izaks GJ, Slaets JP, de Jong PE, Visser ST, Bilo HJ et al. Association of cognitive function with albuminuria and eGFR in the general population. Clin J Am Soc Nephrol 2011; 6:1400-1409.

[38] Heringa SM, van den Berg E, Dekker JM, Nijpels G, Kessels RP, Kappelle LJ et al. Albuminuria and cognitive functioning in an older population: The Hoorn Study. DementGeriatr Cogn Disord 2011; 32:182-187.

[39] Manaviat MR, Afkhami M, Shoja MR. Retinopathy and microalbuminuria in type II diabetic patients. BMC Ophthalmol 2004; 4:9.

[40] Navarro-González JF, Mora C, Muros M, García J, Donate J, Cazaña V. Relationship between inflammation and microalbuminuria in prehypertension. J Hum Hypertens2013; 27:119-125.

[41] Shantha GP, Kumar AA, Bhaskar E, Sivagnanam K, Srinivasan D, Sundaresan M et al. Hypertensive retinal changes, a screening tool to predict microalbuminuria in hypertensive patients: a cross-sectional study. NephrolDial Transplant 2010; 25:1839-1845.

[42] Wu CK, Yang CY, Tsai CT, Chiu FC, Huang YT, Lee JK et al. Association of low glomerular filtration rate and albuminuria with peripheral arterial disease: The National Health and Nutrition Examination Survey, 1999-2004. Atherosclerosis 2010; 209:230-234.

[43] Mensah GA, Croft JB, Giles WH. The heart, kidney, and brain as target organs in hypertension. Cardiol Clin 2002; 20:225-247.

[44] Feldt-Rasmussen B. Microalbuminuria, endothelial dysfunction and cardiovascular risk. Diabetes Metab 2000; 26(Suppl 4):64-66.

[45] Iseki K, Kinjo K, Iseki C, Takishita S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am J KidneyDis 2004; 44:806-814.

[46] Chadban SJ, Briganti EM, Kerr PG, Dunstan DW,Welborn TA, Zimmet PZ et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am SocNephrol 2003; 14(7 Suppl 2):S131-S138.

[47] Viktorsdottir O, Palsson R, Andresdottir MB, Aspelund T, Gudnason V, Indridason OS. Prevalence of chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults. Nephrol Dial Transplant 2005; 20:1799-1807.

[48] Garg AX, Kiberd BA, Clark WF, Haynes RB, Clase CM. Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III. KidneyInt 2002; 61:2165-2175.

[49] Coresh J, Astor BC, Greene T, Eknovan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third national health and nutrition examination survey. Am J Kid Dis 2003; 41:1-12.

[50] Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 2005; 16:180-188.

[51] Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 2006; 17:2275-2284. 8

Seminars in Cardiovascular Medicine

The Journal of Lithuanian Heart Association

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 81 81 8
PDF Downloads 20 20 2