Towards HOMe-based Albuminuria Screening: an Implementation Study Testing Two Approaches
Towards HOMe-based Albuminuria Screening: an Implementation Study Testing Two Approaches
Chronic Kidney Disease (CKD) is a worldwide major public health problem that is associated
 with an increased incidence of kidney failure and cardiovascular events, that lead a high
 burden for affected patients and high costs for society. Symptoms of CKD occur late, when
 kidney function drops to below 30%. At that time preventive measures will have only limited
 efficacy. Protein excretion in urine has increasingly been recognized as early marker of CKD,
 and is often associated with high blood pressure, diabetes, and/or high cholesterol levels.
 These are all important risk factors for progression of kidney and cardiovascular disease.
 Population screening for urinary protein loss could detect a considerable number of subjects
 with yet unknown risk factors for progressive kidney and cardiovascular disease who can
 benefit of early intervention. However, there is no validated method for population screening
 yet. We aim to develop a home based population screening for elevated urinary protein loss.
 We will investigate two screening methods, and evaluate their yield and cost-effectiveness.
Chronic kidney disease (CKD) is a worldwide major public health problem that is associated
 with an increased incidence of kidney failure and cardiovascular disease (CVD). To tackle
 this burden, screening for CKD among the general population could be beneficial to allow
 early detection and treatment. In the last decades, elevated albuminuria has increasingly
 been recognized as an early marker of generalized vascular endothelial damage, that predicts
 CKD and CVD progression.

 It has been estimated that approximately 6% of the general population has elevated
 albuminuria, and that the majority of these subjects are not known yet with this abnormality.
 Among these subjects, many have hypertension, hyperlipidemia, diabetes and/or impaired kidney
 function, that often is also not known yet. Early detection of elevated albuminuria may be
 important because it gives the opportunity to invite subjects that test positive for further
 screening for CKD and CVD risk factors. Thus these risk factors for CKD and CVD progression
 could be treated in an early stage.

 Population screening for albuminuria could be justified according to the WHO criteria of
 Wilson and Jungner , because CKD has important consequences for subjects, the course of the
 disease is initially symptomless, and there are treatment methods available. However,
 implementation research to validate screening the general population for albuminuria and
 related health consequences is lacking, as are cost-effectiveness studies.

 In the current study we aim to develop a home-based screening technique for detecting
 elevated albuminuria. We will investigate two screening methods, and evaluate their yield and
 cost-effectiveness.
Inclusion Criteria:

 -  Age 45 to 80 years.

 -  Living in the municipality of Breda, The Netherlands.

 -  Not institutionalised.

 Exclusion Criteria:

 -  Younger than 45 years or older than 80 years.

 -  Not living in the municipality of Breda, The Netherlands.

 -  Institutionalised.

 A random sample of 15.032 subjects will be drawn from the population aged 45-80 years from
 the municipality of Breda by the Dutch Central Bureau for Statistics (CBS).