Abstract
Chronic kidney disease (CKD) screening beyond patients with diabetes mellitus or hypertension increasingly is discussed. Some guidelines recommend kidney function testing of patients with benign prostatic hyperplasia; however, the significance of extending this to general population screening is unclear. Prospective cohort study. 30,466 men from the HUNT II (Second Health Study in Nord-Trøndelag; 1995-1997) representing 66.8% of the entire adult male population in Nord-Trøndelag County, Norway. The International Prostate Symptom Score was used to detect the presence and severity of lower urinary tract symptoms (LUTS), a surrogate measure of benign prostate hyperplasia suitable for use in general practice. Kidney failure was defined as starting renal replacement therapy or CKD death with a documented stable estimated glomerular filtration rate<15 mL/min/1.73 m2. During 10.5 years of follow-up, 78 men developed kidney failure. Kidney failure risks were 2.60 (95% CI, 1.47-4.58) and 4.08 (95% CI, 1.74-9.53) times higher for men with moderate and severe LUTS compared with men with no/mild LUTS, respectively. However, age-stratified analysis showed that the incidence rate ratio for moderate/severe LUTS versus no/mild LUTS was 1.27 (95% CI, 0.76-2.13), and multivariable Cox analysis showed no significant association between LUTS and risk of kidney failure. Screening effectiveness was improved only slightly by including men with moderate/severe LUTS in addition to patients with diabetes, hypertension, or cardiovascular disease. Better effectiveness was achieved by simply including all men older than 60 years. The ability of the International Prostate Symptom Score to predict the presence and severity of obstruction is only moderate. Ascertainment of severe CKD (estimated glomerular filtration rate, 30-15 mL/min/1.73 m2) was not possible. LUTS were not significantly associated with future kidney failure after adjusting for age and therefore in isolation are not a basis for kidney failure screening.
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