Kidney Disease: catch it early to save lives and money
We all know someone living with chronic kidney disease (CKD) – even if they have not yet been diagnosed: it is estimated that 10 percent of the global population is affected by CKD1. Between 1990 and 2010, kidney disease became one of the fastest-growing causes of death in the world, second only to HIV/AIDS.1
Reviewing the data on CKD diagnosis, we were struck by how timely detection can impact patient outcomes. Catching kidney disease in the early stages is a challenge, since there are typically no overt signs or symptoms. However, if CKD is detected early and managed appropriately, the deterioration in kidney function can be slowed and the risk of associated cardiovascular complications reduced.2
For patients, this can make all the difference, but we know too that there is a real impact for health systems where demand is rising and resources may be scarce. CKD also represents more than €1 trillion in healthcare costs over the next decade.3
Key indicators of kidney function
So, what are the tell-tale signs of kidney problems? The presence of increased amounts of protein (albumin) in urine, or microalbuminuria, is a key indicator of kidney function and is routinely used to monitor the health of patients with diabetes mellitus.
There are a number of tests available for urine creatinine estimation, the majority of which involve chemical or enzymatic reactions. When it comes to routine screening in a point-of-care setting, we believe the best available option is urine ACR.
Like CKD, the prevalence of diabetes is increasing worldwide, with 422 million cases as of 2014.4 A simultaneous creatinine measurement permits normalization of albumin concentration and requires only a single spot test to give the albumin-creatinine ratio (ACR). Yearly urine ACR tests are recommended for patients with diabetes to identify progression of kidney failure (Figure 1).5
Urine dipstick analysis allows for a number of tests to be run at once on one sample. For example, complementary urine tests can aid in assessing carbohydrate metabolism (urine glucose or ketone) or potential infections (leuckocytes). Additionally, urine sediment analysis provides information not available from urine ACR or urine dipstick testing.
Urine sediment analysis has historically been performed manually, but manual analysis is time-consuming and difficult to standardize. Urine dipstick testing has been automated, removing user variation and allowing high-throughput testing that allows more efficient use of laboratory personnel. In recent years, automated methods of sediment analysis have also become available and are likely to be of increasing importance in the future.
Urinalysis is one of the oldest and most established methods of medical diagnostics and remains a simple and rapid means of monitoring patient health.
We see the ability to assess kidney function through urine ACR tests as critical, as it may indicate serious complications that require further investigation. It can also potentially be cost-saving as it can be used to screen for good kidney function, thus avoiding other unnecessary tests.
In light of the continuing burden of chronic disease and rising healthcare costs, we expect urinalysis to continue to be critical in the future.
Routine screening of diabetic patients for early signs of kidney disease with a simple ACR test can improve the quality of life and help control healthcare costs.
- The National Kidney Foundation. Global facts about kidney disease. https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease.
- World Kidney Day: Chronic kidney disease. http://www.worldkidneyday.org/faqs/chronickidney-disease/.
- Scottish Kidney Federation. Chronic kidney disease. http://scotskidneyfederation.org/ckdinformation.html.
- World Health Organization. Factsheets. http://www.who.int/mediacentre/factsheets/fs312/en/.
- The National Kidney Foundation. Diabetes and kidney disease (Stages 1-4). https://www.kidney.org/atoz/content/Diabetes-and-Kidney-Disease-Stages1-4.
Julie Chaney, PhD, and Jeffrey Mayfield, PhD, are Senior Scientists at Siemens Healthineers.