NEW YORK (Reuters Health) – Assessing kidney function with both the estimated glomerular filtration rate (eGFR) and with urinary albumin levels can help predict whether chronic kidney disease will progress to end-stage renal disease (ESRD), new research shows.

“We provide clear evidence … that reduced eGFR should always be complemented by information on urine-albumin to yield optimal prediction of the risk of progression to ESRD,” lead author Dr. Stein I. Hallan, from St. Olav University Hospital, Trondheim, Norway, said in a statement.

The findings, reported in the Journal of the American Society of Nephrology for May, are based on an analysis of data for 65,589 subjects who were enrolled in the Nord-Trondelag Health (HUNT 2) Study from 1995 to 1997. During 10.3 years of follow-up, 124 subjects with chronic kidney disease progressed to ESRD.

On multivariate analysis, both eGFR and albuminuria were found to be independent predictors of progression to ESRD. The lowest eGFR (15 to 29 mL/min per 1.73 m²) increased the odds of ESRD by 65.7-fold relative to a normal eGFR, and macroalbuminuria increased the risk by 47.2-fold (p < 0.001 for both). “Considering both the urinary albumin/creatinine ratio and eGFR substantially improved diagnostic accuracy,” the authors note. Using an eGFR of 15 to 59 mL/min per 1.73 m² as a criteria for ESRD referral would mean that 4.7% of the general population would need to be evaluated and 69.4% of patients who progressed to ESRD would be identified. By contrast, with the combined eGFR/albinuria approach, only 1.4% of the population would need to be evaluated, yet it would still identify 65.6% of ESRD progressors. “Future risk scores and classification systems based on these two variables will be a simple and powerful tool for improving our ability to efficiently handle the large group of patients with chronic kidney disease,” the authors conclude. Reference:
J Am Soc Nephrol 2009.