Skip to main content

Underestimating chronic kidney disease by urine dipstick without serum creatinine as a screening tool in the general Japanese population

Clinical and Experimental Nephrology volume 19, pages 474–480 (2015)Cite this article

Abstract

Background

It is not known if urine dipstick alone can identify chronic kidney disease (CKD) in the general Japanese population.

Methods

We designed a cross-sectional study using data obtained in 2008 from a nationwide community-based health examination program for adults aged 40–74. The data consisted of blood tests, urine tests and questionnaire related to metabolic disorders. Those who had both serum creatinine measured and urine dipstick tested were analyzed.

Results

Data were obtained from 538,846 people with a mean age of 62.8 years, consisting of 41.6 % males. Our study showed that 14.4 % had an eGFR below 60 mL/min/1.73 m2, 5.2 % had proteinuria and 18.1 % had CKD. Within the population with CKD, non-proteinuric CKD accounted for 71.4 %. The proportion of non-proteinuric CKD was highest in stage G3a (91.8 %) followed by G3b (77.0 %) disease, and was greater in the more elderly and in females. The proportion of non-proteinuric CKD was 47.9 % in diabetes mellitus, 69.3 % in dyslipidemia, 66.8 % in hypertension and 57.1 % in metabolic syndrome. Furthermore, non-proteinuric CKD accounted for 78.1 % of the population without these lifestyle diseases, suggesting that even in the population without apparent risk, CKD is still prevalent and can be missed when urine dipstick is the only screening method used.

Conclusions

This study showed that a considerable population of CKD might be overlooked when only dipstick proteinuria is assessed for CKD screening. Hence, we strongly recommend that both urinalysis and serum creatinine measurement should be a part of the nationwide CKD screening system.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Imai E, Yamagata K, Iseki K, et al. Kidney disease screening program in Japan: history, outcome, and perspectives. Clin J Am Soc Nephrol. 2007;2:1360–6.

    PubMed  Article  Google Scholar 

  2. Takeuchi H, Saitoh S, Takagi S, et al. Metabolic syndrome and cardiac disease in Japanese men: applicability of the concept of metabolic syndrome defined by the National Cholesterol Education Program-Adult Treatment Panel III to Japanese men–the Tanno and Sobetsu Study. Hypertens Res Off J Jpn Soc Hypertens. 2005;28:203–8.

    Article  Google Scholar 

  3. Matsuzawa Y. Metabolic syndrome–definition and diagnostic criteria in Japan. J Atheroscler Thromb. 2005;12:301.

    PubMed  Article  Google Scholar 

  4. Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis Off J Natl Kidney Found. 2009;53:982–92.

    CAS  Article  Google Scholar 

  5. Hemmelgarn BR, Manns BJ, Lloyd A, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA J Am Med Assoc. 2010;303:423–9.

    CAS  Article  Google Scholar 

  6. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375:2073–2081.

  7. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA J Am Med Assoc. 2007;298:2038–47.

    CAS  Article  Google Scholar 

  8. Levey AS, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int. 2010;80:17–28.

    PubMed  Article  Google Scholar 

  9. Muntner P. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16:529–38.

    PubMed  Article  Google Scholar 

  10. Nakayama M, Sato T, Miyazaki M, et al. Increased risk of cardiovascular events and mortality among non-diabetic chronic kidney disease patients with hypertensive nephropathy: the Gonryo study. Hypertens Res Off J Jpn Soc Hypertens. 2011;34:1106–10.

    Article  Google Scholar 

  11. Kondo M, Yamagata K, Hoshi S-L, et al. Cost-effectiveness of chronic kidney disease mass screening test in Japan. Clin Exp Nephrol. 2011;16:279–91.

    PubMed Central  PubMed  Article  Google Scholar 

Download references

Acknowledgments

This study was supported by a Health and Labor Sciences Research Grant for “Design of the specific health check for chronic kidney disease (CKD) based on individual risk assessment at Specific Health Checks” from the Ministry of Health, Labor and Welfare of Japan.

Conflict of interest

All authors declare that they have no competing interests.

Author information

Affiliations

  1. Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Daisuke Uchida, Hiroo Kawarazaki, Yugo Shibagaki, Takashi Yasuda, Naoto Tominaga & Kenjiro Kimura

  2. Division of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan

    Tsuyoshi Watanabe & Koichi Asahi

  3. Dialysis Unit, University Hospital of The Ryukyus, 207 Uehara, Okinawa, Nishihara, 903-0215, Japan

    Kunitoshi Iseki & Chiho Iseki

  4. Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, Higashi-ku, 812-8582, Japan

    Kazuhiko Tsuruya

  5. Department of Nephrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan

    Kunihiro Yamagata

  6. Health Care Center, Osaka University, 1-17 Machikaneyama-cho, Osaka, Toyonaka, 560-0043, Japan

    Toshiki Moriyama

  7. Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Chuo-ku Niigata, Niigata, 951-8510, Japan

    Ichiei Narita

  8. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Shoichi Fujimoto

  9. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Tsuneo Konta

  10. Department of Health Care Policy and Management, Graduate School of Comprehensive Sciences, University of Tsukuba, 1-1-1 Tennoudai, Ibaraki, 305-8577, Tsukuba, Japan

    Masahide Kondo

  11. Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan

    Masato Kasahara

Authors
  1. Daisuke Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroo Kawarazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yugo Shibagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naoto Tominaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsuyoshi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koichi Asahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kunitoshi Iseki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chiho Iseki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuhiko Tsuruya
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kunihiro Yamagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Toshiki Moriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ichiei Narita
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Shoichi Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Tsuneo Konta
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Masahide Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Masato Kasahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Kenjiro Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daisuke Uchida.

Additional information

T. Watanabe, K. Asahi, K. Iseki, C. Iseki, K. Tsuruya, K. Yamagata, T. Moriyama, I. Narita, S. Fujimoto, T. Konta, M. Kondo, M. Kasahara and K. Kimura are the members of Steering Committee for Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based On Individual Risk Assessments at Specific Health Check.

D. Uchida and H. Kawarazaki have contributed equally to this manuscript.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Uchida, D., Kawarazaki, H., Shibagaki, Y. et al. Underestimating chronic kidney disease by urine dipstick without serum creatinine as a screening tool in the general Japanese population. Clin Exp Nephrol 19, 474–480 (2015). https://doi.org/10.1007/s10157-014-1019-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-014-1019-5

Keywords

  • Chronic kidney disease
  • Screening
  • Urine dipstick test