Abstract
Chronic kidney disease (CKD) is a public health problem and its prevalence has increased worldwide; patients are commonly unaware of the condition. The present study aimed to investigate whether exhaled breath ammonia via vertical-channel organic semiconductor (V-OSC) sensor measurement could be used for rapid CKD screening. We enrolled 121 CKD stage 1–5 patients, including 19 stage 1 patients, 26 stage 2 patients, 38 stage 3 patients, 21 stage 4 patients, and 17 stage 5 patients, from July 2019 to January 2020. Demographic and laboratory data were recorded. The exhaled ammonia was collected and rapidly measured by the V-OSC sensor to correlate with kidney function. Results showed no significant difference in age, sex, body weight, hemoglobin, albumin level, and comorbidities in different CKD stage patients. Correlation analysis demonstrated a good correlation between breath ammonia and blood urea nitrogen levels, serum creatinine levels, and estimated glomerular filtration rate (eGFR). Breath ammonia concentration was significantly elevated with increased CKD stage compared with the previous stage (CKD stage 1/2/3/4/5: 636 ± 94; 1020 ± 120; 1943 ± 326; 4421 ± 1042; 12781 ± 1807 ppb, p < 0.05). The receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.835 (p < 0.0001) for distinguishing CKD stage 1 from other CKD stages at 974 ppb (sensitivity, 69%; specificity, 95%). The AUC was 0.831 (p < 0.0001) for distinguishing between patients with/without eGFR < 60 mL/min/1.73 m2 (cutoff 1187 ppb: sensitivity, 71%; specificity, 78%). At 886 ppb, the sensitivity increased to 80% but the specificity decreased to 69%. This value is suitable for kidney function screening. Breath ammonia detection with V-OSC is a real time, inexpensive, and easy to administer measurement device for screening CKD with reliable diagnostic accuracy.
Highlights
Chronic kidney disease (CKD) has become an emerging public health problem and a major economic and social burden
Our findings showed breath ammonia concentration was increased with the patients progression of stages and that there was a strong correlation between breath ammonia and kidney function
To increase the test sensitivity to 80%, breath ammonia was set at a concentration of 886 ppb, CKD stages and that there was a strong correlation between breath ammonia and kidney function
Summary
Chronic kidney disease (CKD) has become an emerging public health problem and a major economic and social burden. One of fast and simple detection methods is exhaled breath ammonia measurement that has been intensively investigated in CKD and dialysis subjects. One study compared breath ammonia in 27 CKD stage 3–5 patients with 15 healthy subjects [22]. Our recent study demonstrated that breath ammonia concentration was strongly correlated with the BUN level in 34 CKD stage 3–5 patients, and it was a good predictor to distinguish healthy individuals and these CKD patients [28]. These studies used healthy subjects as controls and had a small-number size, and their results require verification by large-scale studies. We determined whether breath ammonia was a useful screening tool to distinguish between all stages of CKD patients in a study with a larger sample size
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