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Performance of Current Chronic Kidney Disease Screening Criteria in Women and Men Across Ethnic Groups: The HELIUS
Taryn G Vosters1, Vianda S Stel2,3, Kitty J Jager2,3
1Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Insights
Current chronic kidney disease (CKD) screening guidelines may miss women and diverse ethnic groups. Optional factors like obesity showed limited improvement, highlighting a need for better CKD detection strategies.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Current screening guidelines for chronic kidney disease (CKD) are based on hypertension, diabetes mellitus, and cardiovascular disease.
- The effectiveness of these criteria in detecting CKD equally across different sexes and ethnic groups is not well understood.
- Optional criteria such as education, occupation, obesity, and genetic risk factors are mentioned in guidelines but their added value is unclear.
Purpose of the Study:
- To evaluate if current CKD screening criteria (hypertension, diabetes, cardiovascular disease) equally identify CKD in women and men across various ethnicities.
- To determine if incorporating optional criteria (education, occupation, obesity, genetic risk) improves CKD detection performance.
- To assess the performance of screening criteria using metrics like AUC, sensitivity, and specificity by sex and ethnicity.
Main Methods:
- Analysis of data from 12,384 women and 9,046 men from the HELIUS Study (Amsterdam, Netherlands).
- CKD defined by estimated glomerular filtration rate <60 mL/min/1.73 m² or albumin-to-creatinine ratio >3 mg/mmol.
- Poisson regression used to assess associations between CKD and optional criteria; model comparisons via likelihood ratio tests and AIC; AUC, sensitivity, specificity, PPV, NPV calculated by sex and ethnicity.
Main Results:
- CKD prevalence varied from 2.9% to 8.8% in women and 3.2% to 8.6% in men.
- Low educational level (women only) and obesity significantly improved CKD detection models.
- Optional criteria did not substantially enhance predictive measures across ethnic groups; AUC was 0.75 for men and 0.65 for women.
Conclusions:
- Existing CKD screening criteria may not effectively detect disease equally in women and men across different ethnic backgrounds.
- The inclusion of optional criteria demonstrated limited additional value in improving CKD detection performance.
- Further research is needed to refine screening strategies for equitable CKD detection in diverse populations.
Objective:
To investigate whether the currently recommended screening criteria in Kidney Disease: Improving Global Outcomes 2024 guidelines (hypertension, diabetes mellitus, and cardiovascular disease) equally detect women and men across ethnic groups and whether consideration of optional criteria (education level, occupation, obesity, and genetic risk factors) listed in the guideline improves performance.
Patients And Methods:
We included 12,384 women and 9046 men of Dutch, South Asian and African Surinamese, Ghanaian, Turkish, and Moroccan origin from the baseline HELIUS Study (January 1, 2011, through December 31, 2015, Amsterdam, the Netherlands). Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 or albumin-to-creatinine ratio of >3 mg/mmol. Poisson regression analyses estimated associations between CKD and optional criteria on top of current screening criteria. Model comparisons were made with likelihood ratio tests and Akaike information criterion estimations in women and men. Area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated by sex and ethnicity.
Results:
Chronic kidney disease prevalence ranged from 2.9% to 8.8% in women and 3.2% to 8.6% in men. Low educational level (women only) and obesity significantly improved the models with current criteria with CKD. High-risk occupations and polygenic risk score did not improve the model. However, these criteria did not improve predictive measures across ethnic groups. Overall, the AUCs for the current screening criteria were acceptable in men (AUC, 0.75; 95% CI, 0.73-0.77) and poor in women (AUC, 0.65; 95% CI, 0.63-0.67), and showed minimal change after adding the optional criteria.
Conclusion:
Current screening criteria may not be equally detecting women and men across ethnic groups with CKD. Optional criteria had limited added value.
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