Serum and urinary markers of early impairment of GFR in chronic kidney disease patients: diagnostic accuracy of urinary β-trace protein

Abstract

The screening for chronic kidney diseases (CKD) patients with impaired GFR needs the measurement of serum creatinine (SCr) or cystatin C (SCys). GFR can also be predicted from SCr or SCys with different formulas. The aim of this study, performed in a group of CKD patients with different levels of GFR, was to evaluate the possibility to select the patients with a GFR <90 ml·min−1·1.73 m−2by means of serum levels and urinary excretion of different low-molecular-weight proteins (LMWP), cystatin C (Cys), β2-microglobulin (β2M), retinol-binding protein (RBP), β-trace protein (BTP), and derived prediction equations for GFR. In the 295 CKD patients (137 women), at all stages of GFR impairment a very high correlation was found between GFR (99mTc-DTPA) and serum Cr, Cys, β2M, and BTP. All these serum markers showed a similar accuracy as indicators of different GFR impairments. RBP had the lowest correlation with GFR and was also significantly less accurate. The different prediction formulas derived from gender, anthropometric data and SCr or S-LMWP had a diagnostic accuracy similar to that of serum Cr, Cys, β2M, and BTP. Urinary albumin was inadequate as an indicator of any level of GFR impairment. Urinary excretion of Cys and β2M increased significantly only in patients with a GFR <30 ml·min−1·1.73 m−2, while urinary BTP increased already at GFR <90 ml·min−1·1.73 m−2. In this selected group of CKD patients, the positive predictive value of urinary BTP for a GFR <90 ml·min−1·1.73 m−2was 85%, indicating that, in CKD patients, a urine-based test can predict a slight GFR impairment.