Singapore ranks 6th in the world for the number of kidney failure cases.
200,000 Singaporeans may be unaware that they have Chronic Kidney Disease (CKD). If left undetected and unmanaged, CKD will progress to kidney failure.
Early detection and treatment can delay the disease’s progression and the need for dialysis by as many as 10 years or more.
Our kidneys play a vital role in maintaining our overall health by filtering waste and excess fluids from our blood. However, Chronic Kidney Disease (CKD) often develops and progresses silently until its advanced stages. If left undetected and unmanaged, CKD will progress to kidney failure. Conversely, when CKD is detected and treated early, the disease progression and need for dialysis can be delayed by as many as 10 years or more.
This is where chronic kidney screening tests are of importance.
Parkway Laboratories offers kidney screening tests that offer valuable insights into kidney function and potential damage.
Evaluating Kidney Function – eGFR
Glomerular filtration rate (GFR), is widely recognised as the best indicator of kidney function. GFR measures the rate the kidney is filtering waste and excess fluids from the blood. Thus, serving as a gauge of its functional health. However, measuring "true" GFR can be complex and challenging. Thus, healthcare professionals use serum creatinine-based estimating equations to calculate the estimated GFR (eGFR).
Studies have found that the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, adopted by Parkway Laboratories, fairly accurately estimates glomerular filtration (eGFR) rate.
This method allows for a reasonably simple CKD screening with a blood test.
Note: The CKD-EPI equation is not suitable for children (age <18 years), pregnant women and in some racial or ethnic subgroups.
Detecting Kidney Damage - Urine Microalbumin/Creatinine Ratio
While GFR provides a vital assessment of kidney function, evaluating kidney damage is equally important. In the early stages of kidney disease, small amounts of albumin, a protein normally found in the blood, will begin to leak into urine. This condition, called microalbuminuria, is an early indicator of kidney damage. Early detection of microalbuminuria by a simple urine test provides the opportunity for early intervention to slow down the progression of CKD.
CKD Stages and Classification
Healthcare professionals risk stratify patients using these results to aid them with planning follow up and management. Patients with CKD can be classified based on their eGFR and Urine Microalbumin/Creatinine Ratio results. The lower the eGFR and the greater the amount of protein present in the urine, the more “severe” the CKD.
Note: All results should be correlated with patient’s history and clinical findings. Therefore, your physician is the best person to interpret your laboratory results. Always consult your physician.
Annual Screening Recommended for Individuals at Higher Risk
For individuals at higher risk of developing CKD, an annual screening is recommended.
Risk factors:
- Pre-existing medical conditions such as diabetes, hypertension, obesity, and/or heart disease.
- A family history of kidney disease, diabetes, and/or hypertension.
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References:
- USRDS Annual Report 2022 (2022). Accessed from: https://usrds-adr.niddk.nih.gov/2022/end-stage-renal-disease/11-international-comparisons
- ACE Clinical Guidance: Chronic Kidney Disease – Early Detection (2022). Accessed from: https://www.ace-hta.gov.sg/docs/default-source/acgs/ckd-early-detection-%28october-2022%29.pdf
- Chronic Kidney Disease: What You Need to Know and How to Manage It (2023). Accessed from:
https://www.channelnewsasia.com/singapore/chronic-kidney-disease-failure-singapore-early-screening-nkf-dialysis-3620561 - The College of American Pathologists. Current status of reporting estimated glomerular filtration rate (eGFR) for adults. Accessed from: http://www.cap.org/apps/docs/committees/chemistry/current_status_of_reporting_eGFR_2011.pdf. Accessed December 11, 2020
- American Medical Association. Comparison of Risk Prediction Using the CKD-EPI Equation and the MDRD Study Equation for Estimated Glomerular Filtration Rate. Accessed from: https://jamanetwork.com. Accessed December 11, 2020.
- The International Society of Nephrology. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Accessed from: http://www.kidney-international.org. Accessed December 11, 2020.
This article has been reviewed by Dr Leslie Lam, Consultant Chemical Pathologist.
Dr Lam is a Deputy Medical Director and Clinical Governance Officer at Parkway Laboratories. He is also the current President of the Singapore Association of Clinical Biochemists (SACB).
