Previous research among participants of PREVEND and Lifelines had already shown that too much protein in the urine is a signal of kidney damage. Kidney damage that remains untreated can eventually lead to kidney failure as well as cardiovascular disease, often with serious consequences. Kidney damage is often detected far too late, because most people only develop symptoms when their kidney function has dropped below 25%. By then, kidney damage is irreversible and cardiovascular diseases have often developed as well.
Thus, early detection of kidney damage (before symptoms and complications occur) is essential. If kidney damage is detected in time, much damage to both kidneys and the cardiovascular system can be prevented with lifestyle modification and medication. This is good for the patient, but also for society as a whole. Around 1.7 million Dutch people have chronic kidney damage. Many of these people die of cardiovascular disease and 18,000 eventually need kidney dialysis or receive a kidney transplant. This makes it a major cost item within healthcare.
You can’t treat what you don’t know
Researchers from the UMCG, together with the Amphia hospital, the municipality of Breda and GPs and lab technicians in the region, investigated suitable methods for this early detection in the Niercheck study. A simple home test, in which the participant collects some urine in a tube at home and then sends this tube to a laboratory, proved to be very effective. Around 60% of the individuals contacted participated in the study. In 3.3% of them, excessive protein was detected in the urine, leading to invitations for follow-up research. In a substantial amount of these participants abnormalities that had not yet been diagnosed were detected, such as high blood pressure, elevated cholesterol, diabetes, and reduced kidney function. Many of these are highly treatable.
Loyal Groningers, involved Brabanders
Much of the knowledge about the value of protein in urine as a 'marker' of kidney damage comes directly from UMCG research with PREVEND and Lifeline participants. Meanwhile, protein loss is used worldwide as an indicator of kidney damage and research and treatment guidelines have been adapted accordingly. Urine protein loss has therefore been made part of the definition of kidney disease by the World Health Organisation. This knowledge is directly due to the cooperation of loyal Groningers, many thousands of whom have faithfully participated in PREVEND and Lifelines scientific studies for 25 years.
The Niercheck study was conducted in the city of Breda, where 15,000 residents aged 45 to 80 were asked to take the urine test at home. A large majority of them participated in the study. Together with the Amphia hospital in Breda and GPs and laboratories in the region, the home tests were analysed and participants who indeed had too much protein in their urine were offered follow-up testing and treatment. The project was led by Ron Gansevoort, professor of kidney diseases at the UMCG.
Steps towards population screening
The Niercheck study not only shows that the Dutch population is willing to participateto a simple home test for kidney problems, the first results of the screening cost-effectiveness study also show that medical gains can be achieved at acceptable costs.
To achieve even greater health gains, all of these parties are joining forces again in follow-up research in the fall of 2023. A large grant of nearly 10 million has been made available for this by NWO and others. The ultimate goal is to see if this can lead to a national population study, for example by combining the urine test with the existing Population Screening for Bowel Cancer. Urine and stool are then sent together to the laboratory to detect kidney disease and colon cancer.
The research was made possible by grants from the Kidney Foundation, Health~Holland, Top Sector Life Sciences & Health of the Ministry of Economic Affairs.
The full article was published today in the Lancet.