DETECTING CHRONIC KIDNEY DISEASE BY LEVERAGING SCREENING INITIATIVES FOR OTHER NON-COMMUNICABLE DISEASES

Abstract

Objective: Early diagnosis of chronic kidney disease (CKD) slows disease progression and reduces mortality; yet screening for CKD is sparse in clinical practice. Contrary, screening for CKD risk factors like hypertension and type 2 diabetes mellitus (T2DM) are included in clinical practice guidelines in most countries. Therefore, an opportunity exists to implement CKD screening as a by-product of these existing screening programmes. To evaluate the viability of CKD screening, we used the South African Diabetes Prevention Programme (SA-DPP) to assess the yield of CKD cases. Design and method: The SA-DPP was conducted across 16 resource-poor communities in Cape Town, South Africa, between 2017 and 2019. Participants, aged 25–65 years, were recruited by random and self-selected sampling techniques. The African diabetes risk score (ADRS), which is a screening tool comprising non-laboratory-based variables including age, waist circumference and the presence of hypertension, was used to identify adults at high risk for T2DM. Those at high-risk were invited for confirmatory oral glucose tolerance test (OGTT). Kidney function was estimated using the serum creatinine-based CKD Epidemiology Collaboration equation. CKD was defined as an estimated glomerular filtration rate (eGFR) of < 90 ml/min/1.73 m2 and/or albumin-to-creatinine ratio > 3 mg/mmol. Results: Of the 2039 individuals screened in the community, 690 participants deemed at high-risk of T2DM presented at the research clinic for an OGTT. Of these individuals, 9.6% (n = 66) had diabetes and 18.1% (n = 125) had CKD, with 2.2% (n = 15) presenting with both CKD and T2DM. Most CKD cases were in the early stages of the disease, with 73.6% (n = 92), 17.6% (n = 22) and 7.2% (n = 9) presenting with stage 1–3, respectively. Of those with CKD stages 1–3, 72.8%, 68.2% and 44.5% had microalbuminuria, respectively with 27.2%, 31.8% and 11.1% presenting with macroalbuminuria. Most participants with early-stage CKD were overweight/obese (95.1%) and 47.0% had hypertension. Conclusions: By including markers of kidney function into the scope of markers collected in an existing disease screening programme, we were able to detect a great proportion of CKD cases. Therefore, by utilizing an opportunistic approach, people with early-stage CKD can be identified and appropriately treated.