Screening for Ocult Renal Disease (SCORED): marcadores associados ao diagnóstico e à mortalidade após dez anos de avaliação

Abstract

Chronic kidney disease (CKD) is subject to population screening as it is serious, frequent and meets the epidemiological criteria that classify the need for screening for a pathology. In Brazil, according to the 2022 survey on patients on dialysis therapy, it was estimated that there were more than 150 thousand patients on dialysis. The main causes of CKD are Diabetes Mellitus (DM) and Systemic Arterial Hypertension (SAH) and, in the context of these pathologies, factors that are associated with worse disease progression are uncontrolled SAH, proteinuria, anemia, acidemia, hyperuricemia, among others. Some factors, such as the presence of glomerular hematuria (HtG) in the urinary sediment, have a wellestablished importance in the context of immunoglobulin A glomerulopathy, however, their importance in the general condition of CKD is still controversial. In 2014, a study was carried out at the Federal University of Juiz de Fora to validate the Screening for Occult Renal Disease (SCORED) questionnaire in the general population. The objective of this study was to evaluate whether sociodemographic factors and the presence of hematuria are associated with mortality in CKD and whether there is a variation in the disease's diagnostic markers, making it therefore necessary to measure them at two moments during CKD screening. A prospective cohort study was carried out from 2011 to 2022. Participants who took part in the SCORED study were included and, in Phase 1, sociodemographic, clinical, pathological and laboratory variables were evaluated. In the second Phase, the outcome is death. A descriptive statistical analysis was carried out, the variables associated with the CKD diagnostic criteria were compared over a three-month interval. Individuals with and without CKD were compared; survivors and non-survivors by Chi-Square, Fisher, tStudent or ANOVA tests. And, finally, factors associated with survival adjusted for confounders by a Cox Regression model. Considered a 95.0% confidence interval. The initial sample size was six hundred participants and CKD was diagnosed, in the first examination, using the criteria of estimated glomerular filtration (FGe)  60 mL/min/1.73 m2 in 8.8%, Albumin/Creatinine Ratio (ACR) altered in 5.0% and presence of HtG in 16.3%, having been confirmed in the second exam using the same criteria: FGe  60 mL/min/1.73 m2 in 3.5%, RAC altered in 3.0 % and presence of HtG in 9.5%. Regarding CKD  non-CKD, a higher prevalence was observed in non-whites and the elderly; laboratory results, higher levels of total cholesterol and LDL cholesterol. In the second Phase, a sample of 103 participants was obtained, comparing death to non-death. The sociodemographic, clinical and pathological variables that were associated with death were older people, lower income, higher systolic and diastolic blood pressure, personal history of SAH, DM, coronary disease and smoking. In the laboratory, higher levels of uric acid and blood glucose. Only age and HtG were predictors of mortality. It was concluded that there was variability in the diagnostic markers of CKD, thus reinforcing the importance of being evaluated at two moments. HtG was not only the diagnostic marker with the least variability, but also a marker of mortality.