CKD screening: urinary albumin or uDKK3 or both?

Area of Science:

• Nephrology
• Biomarker Discovery
• Clinical Diagnostics

Background:

• Chronic kidney disease (CKD) affects 750 million people worldwide, posing significant cardiovascular risks.
• Current CKD diagnosis relies on eGFR and albuminuria, which may miss progressive kidney function decline due to tubulointerstitial injury, known as non-albuminuric CKD.

Purpose of the Study:

• To evaluate urinary Dickkopf-3 (uDKK3) as an early biomarker for progressive CKD.
• To assess the utility of uDKK3 in identifying high-risk individuals, particularly those with non-albuminuric CKD.

Main Methods:

• Clinical studies involving diverse CKD etiologies in adults and children.
• Analysis of uDKK3 levels in urine as a marker of proximal tubular epithelial cell injury and fibrogenic activity.
• Statistical adjustment for established CKD risk markers, including albuminuria.

Main Results:

• Elevated uDKK3 levels significantly improved the detection and prediction of progressive CKD.
• uDKK3 identified high-risk individuals for kidney function decline in non-albuminuric populations, including those with type 2 diabetes, heart, and lung diseases.
• Findings support distinct pathways of CKD progression (glomerular vs. tubulointerstitial injury).

Conclusions:

• Urinary Dickkopf-3 (uDKK3) is a promising biomarker for progressive CKD, complementing albuminuria screening.
• Integrating tubular markers like uDKK3 into screening strategies can enhance early detection and risk stratification for CKD.
• This approach acknowledges different CKD progression pathways, leading to more comprehensive kidney disease management.