*Screening for Albuminuria at the first line for early identification of chronic kidney disease

Kidney disease, cardiovascular disease and Diabetes Mellitus are closely
interrelated. Reducing modifiable cardiovascular risk factors has an effect on
preventing both cardiovascular and renal damage. Early detection and
appropriate treatment of kidney disease is important as this may prevent future
cardiovascular complications and end-organ damage more effectively than
intervention in more advanced stages of disease. There is a well-established
relationship between albuminuria and renal- and cardiovascular disease.
Elevated albuminuria has a relatively high prevalence in the general population
(5-9%). The prevalence of albuminuria is even higher in patients with type 2
Diabetes Mellitus (20-40%) and in patients with hypertension (10-15%). Adequate
treatment of albuminuria, preferable at early stages can prevent both
cardiovascular and renal disease progression. However, scarce epidemiological
data show that albuminuria measurements are only conducted in a minority of
individuals and disease recognition is suboptimal, even in high-risk groups.
This leaves a large proportion of patients not identified, and thus not
adequately treated. The current study aims to evaluate if and how early
identification of chronic kidney disease by targeted screening of albuminuria
levels is feasible in primary care (pharmacies and general practitioners) to
optimally discover and treat patients with elevated albuminuria.

Primary objectives:
To perform a study to:
1. Estimate the prevalence of elevated albuminuria in subjects with a high risk
of chronic kidney disease in the Netherlands.
2. Evaluate which screening approach would be most effective based on costs per
identified patient with elevated albuminuria, via pharmacies or general
practices.

Secondary objectives:
1. To estimate the prevalence of unrecognized chronic kidney disease in
subjects with a high risk of chronic kidney disease.
2. To estimate the prevalence of persistent elevated albuminuria under adequate
treatment with renin-angiotensin system (RAS) inhibitors in subjects with a
high risk of chronic kidney disease.
3. To assess frequency of cardiovascular risk monitoring by general
practitioners after targeted albuminuria screening.
4. To assess changes in cardio-metabolic drug prescriptions after targeted
screening.

Cross-sectional study in Dutch pharmacies and general practices.

All selected subjects will be asked to participate on a free-will base and to
send a signed informed consent form with a completed short questionnaire to
GPRI. They will be asked to collect urine using the PeeSpot and to send this to
a laboratory by postal mail for a measurement of albuminuria. Subjects will be
informed about the results and, only in case of elevated albuminuria levels,
the subject will be asked to repeat the procedure for a confirmational
measurement. If the confirmational measurement is negative, a third measurement
is needed. If recent (<11 months ago) albuminuria levels were available from
the general practice and found to be elevated as well, a second confirmational
PeeSpot measurement will not be needed. If recent albuminuria levels were not
elevated, subjects will not be approached for this study.

When albuminuria is confirmed, treatment status will be reviewed and
cardiovascular risk factors will be assessed during a visit. Length, weight,
blood pressure, heart rate, point of care HbA1c and creatinine will be
measured. Measurements performed during this visit are non-invasive and part of
standard care in general practice and therefore not associated with additional
risks. A benefit for the patient could be that elevated albuminuria may be
detected earlier because of the screening, and thus comes with health benefits,
such as adequate treatment of impaired renal function and medication monitoring
by the pharmacy, which has been proven to be effective in preventing adverse
events of medication.