Estimating Glomerular Filtration Rates and Metabolic Disturbance in the Community: Short-Term Observation of the Compound Community Screening Program in Chiayi City

Friday, 11 July 2008: 10:20 AM
Wen-Chun Chen, RN , Community Medicine Department, St. Martin De Porres Hospital, Chiayi City, Taiwan
Hung-Bin Tsai, MD , Center for chronic kidney diease care and health promotion, St. Martin De Porres Hospital, Chiayi City, Taiwan
Chiu-Chu Lin, PhD , School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan

Learning Objective 1: compare the four different eGFR equations and understand the CKD staging.

Learning Objective 2: find out the link between metabolic characteristics and urinary abnmormalities of the stage 3~5 CKD subjects

Background: There is highest prevalence rate of end-stage renal disease in Y-Lin, Chiayi, and Tainan area in Taiwan. Screening for proteinuria, glucosuria and hematuria by a simple dipstick test can be useful for detecting cardinal signs of underlying renal abnormality. St. Martin De Porres Hospital, a regional teaching hospital in Chiayi City, conducted a community-based multiple screening program and applied four equations for estimating glomerular filtration rate (eGFR) by CCR(MDRD-USA), CCR(MDRD-China), CCR(MDRD-Japan), CCR(CCG) to screen stage 3-5 chronic kidney disease (CKD) subjects. The aim of this study was to find the most efficient method to identify stage 3-5 CKD adults with renal abnormalities and metabolic disturbance in CKD endemic areas of Taiwan.

Method: A prospective, cross-sectional, community-based study was conducted in Chiayi City from April to August 2007. Eligible subjects age 30 years or over and native to Chiayi City were submitted biochemical profiles and urinalysis by dipstick. CKD stage 3-5 subjects were further studied using the four eGFR equations.

Results: Among the 1360 study subjects (male 38.3%), mean age was 56.0511.67 year-old, creatinine 0.840.23 mg/dL, Comparing metabolic disturbance of CKD stage 3-5 subjects by eGFR equations, there were significant differences among the four groups: CCR(MDRD-USA) found a higher ratio of: 1) female waist circumference³80cm, 2) total cholesterol ³200mg/dL, 3) triglyceride³150mg/dL, and 4) body mass index³22 kg/m2. In CCR(MDRD-USA) group (n=21), 33.3% having urine protein³1+ compared to CCR(MDRD-China) (n=57) 24.6%, CCR(MDRD-Japan) (n=527) 7.4% and CCR(CCG) group (n=160) 16.3% was statistically significant (p< 0.01).

Conclusion:CCR(MDRD-USA) with dipstick can be an efficient screening tool for identifying CKD stage 3-5 subjects in a community-based multiple screening program.