Mismatch in kidney tests may reveal hidden health risks – News-Medical

Report on Advanced Kidney Function Assessment and its Contribution to Sustainable Development Goals

Introduction: Aligning Kidney Health with Global Development Targets

A recent global study reveals that a combined approach to kidney function testing, utilizing both creatinine and cystatin C biomarkers, significantly enhances the early detection of severe health risks. This advancement directly supports the achievement of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. By improving the diagnosis of chronic kidney disease (CKD), a leading cause of global mortality, this research provides a critical tool for reducing premature mortality from non-communicable diseases (NCDs), a key target under SDG 3.4.

Key Research Findings

The investigation, led by researchers at NYU Langone Health and conducted by the Chronic Kidney Disease Prognosis Consortium, analyzed data from 860,966 individuals. The primary findings highlight a critical diagnostic gap with significant implications for public health.

• Diagnostic Discrepancy: A significant mismatch was observed between kidney function measurements derived from creatinine and those from cystatin C. Over one-third of hospitalized study participants showed a cystatin C-based kidney function reading that was at least 30% lower than their creatinine-based result.
• Predictive Power: This discrepancy is a powerful predictor of adverse health outcomes. Individuals with a notable gap between the two test results faced a higher risk of:
  • Kidney failure requiring dialysis or transplantation
  • Heart disease and heart failure
  • All-cause mortality
• Broad Applicability: The predictive value of this discrepancy was not limited to hospitalized patients; it was also observed in 11% of outpatients and seemingly healthy volunteers, indicating its utility for broader population screening.

Implications for Sustainable Development Goal 3 (Good Health and Well-being)

The study’s outcomes have profound implications for global health policy and the pursuit of SDG 3. The enhanced diagnostic accuracy offered by dual-marker testing is a direct contributor to several specific targets.

1. Target 3.4: Reduce Premature Mortality from NCDs: CKD is a major NCD and the ninth leading cause of death globally. By identifying at-risk individuals earlier and more accurately, the dual-testing method enables timely intervention, helping to prevent disease progression and reduce premature deaths.
2. Target 3.8: Achieve Universal Health Coverage (UHC): A core component of UHC is access to quality essential health-care services, including diagnostics. The research underscores the need to integrate cystatin C testing into standard clinical practice to improve the quality of care. The current low adoption rate—with less than 10% of U.S. labs performing the test in-house as of 2019—represents a significant gap in achieving UHC.

Recommendations for Policy and Practice

To leverage these findings and accelerate progress towards global health goals, the following actions are recommended:

• Update Clinical Guidelines: Health organizations should advocate for the revision of clinical guidelines to recommend the concurrent use of creatinine and cystatin C for assessing kidney function, especially in older, sicker, or high-risk populations.
• Expand Access to Diagnostics: Efforts must be made to increase the availability and affordability of cystatin C testing in clinical laboratories worldwide. This is essential for ensuring equitable access to high-quality diagnostics, a cornerstone of UHC.
• Enhance Physician Education: Medical professionals should be educated on the clinical value of interpreting discordant results from the two tests to better inform patient management, including appropriate drug dosing and risk stratification.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article is fundamentally centered on health. It discusses chronic kidney disease as the “ninth leading cause of death globally” and its connection to other serious health issues like heart disease. The core topic is the improvement of diagnostic methods (using both creatinine and cystatin C tests) to better manage a non-communicable disease, ensure patients receive “swift treatment,” and ultimately promote healthier lives and well-being, which is the essence of SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

  The article directly relates to this target by focusing on chronic kidney disease and heart disease, both of which are major non-communicable diseases (NCDs). The research presented aims to “identify far more people with poor kidney function, and earlier in the disease process.” This early detection is a critical component of prevention and treatment strategies designed to reduce premature deaths from NCDs and avoid severe outcomes like the need for “dialysis and organ transplantation.”

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Official Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.

  The article explicitly mentions that a mismatch between the two kidney tests indicates a “higher risk for kidney failure, heart disease, and death.” It also states that chronic kidney disease is the “ninth leading cause of death globally.” This directly connects to measuring mortality rates from NCDs, as improving kidney function diagnosis would help lower mortality attributed to both kidney and heart disease.

• Implied Indicator: Prevalence and early diagnosis of chronic kidney disease.

  The article notes that “a record number of people worldwide have chronic kidney disease.” A key goal of the new diagnostic approach is to “spot the condition early.” Therefore, tracking the prevalence of the disease and, more importantly, the rate of early diagnosis would serve as a direct measure of progress in managing this NCD.

• Implied Indicator: Utilization rate of advanced diagnostic tests.

  Progress can be measured by the adoption of the recommended testing. The article points out a significant gap, stating that in 2019, “less than 10% of clinical laboratories in the United States performed” cystatin C testing in-house and that “less than 1% were tested for cystatin C” among hospitalized Americans in the study. An increase in the use of this more effective diagnostic tool would be a clear indicator of improved healthcare practices aligned with the SDG target.

4. SDGs, Targets, and Indicators Table

Source: news-medical.net