title: Underestimating chronic kidney disease by urine dipstick without serum creatinine as a screening tool in the general Japanese population.
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 m(2), 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.
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. uchidadaiske@gmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Uchida
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kawarazaki
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tominaga
authors.affiliation: Division of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Asahi
authors.affiliation: Dialysis Unit, University Hospital of The Ryukyus, 207 Uehara, Okinawa, Nishihara, 903-0215, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.affiliation: Dialysis Unit, University Hospital of The Ryukyus, 207 Uehara, Okinawa, Nishihara, 903-0215, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Iseki
authors.affiliation: 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.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.affiliation: Department of Nephrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamagata
authors.affiliation: Health Care Center, Osaka University, 1-17 Machikaneyama-cho, Osaka, Toyonaka, 560-0043, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Moriyama
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Chuo-ku Niigata, Niigata, 951-8510, Japan.
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.affiliation: Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Fujimoto
authors.affiliation: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Konta
authors.affiliation: Department of Health Care Policy and Management, Graduate School of Comprehensive Sciences, University of Tsukuba, 1-1-1 Tennoudai, Ibaraki, 305-8577, Tsukuba, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kasahara
authors.affiliation: Department of Nephrology and Hypertension, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011507:Proteinuria / Q000175:diagnosis* / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D016482:Urinalysis / Q000379:methods
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; Screening; Urine dipstick test