Albuminuria Screening May Predict Rapid eGFR Decline

Screening for elevated albuminuria and hypertension may identify a group of patients at increased risk of faster decline in kidney function, reports a study in Nephrology Dialysis Transplantation.

The study included 6471 participants from the population-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. All had at least two (median four) measurements of estimated glomerular filtration rate (eGFR) over a median 11.3 years’ follow-up. Elevated albuminuria was defined as an albumin concentration of 20 mg/L or higher in a first morning urine sample, confirmed by an albumin excretion of 30 mg/d or higher in two 24-hour urine collections. Hypertension was defined as a blood pressure of 140/90 mm Hg or higher or use of antihypertensive drugs.

Participants with elevated albuminuria had a faster rate of decline in eGFR during follow-up. This was so in subjects with known hypertension, −1.84 versus −1.16 mL/min/1.73 m2 per year; newly diagnosed hypertension, −1.59 versus −1.14 mL/min/1.73 m2 per year; and normal blood pressure, −1.18 versus −0.81 mL/min/1.73 m2 per year.

The association was strongest in participants aged 55 or older and in men. Participants with elevated albuminuria had consistently higher blood pressure. Elevated albuminuria and as yet unknown hypertension was associated with the highest blood pressure. This combination was more than twice as common as elevated albuminuria with known hypertension.

Identifying CKD at an early stage might help to prevent ESRD by managing hypertension and albuminuria. Population screening for albuminuria might aid in identifying patients at risk of faster decline in kidney function, who could benefit from treatment. This strategy may be most effective in men and in older patients; the authors suggest the possibility of combining albuminuria screening with colorectal cancer screening [Özyilmaz A, et al. Screening for elevated albuminuria and subsequently hypertension identifies subjects in which treatment may be warranted to prevent renal function decline. Nephrol Dial Transpl 2016; doi: 10.1093/ndt/gfw414].


February 2017 (Vol 9, Number 2)