ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO883

Impact of Urinary Protein Examination on Early Diagnosis of CKD: A Nationwide Hospital-Based Observational Study in Japan, REAL-CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention


  • Maruyama, Shoichi, Dep. of Neph, Nagoya Univ., Aichi, Japan
  • Tanaka, Tetsuhiro, Dep. of Neph, Tohoku Univ., Miyagi, Japan
  • Takeda, Masayoshi, AstraZeneca K.K., Osaka, Japan
  • Morita, Naru, AstraZeneca K.K., Osaka, Japan
  • Yajima, Toshitaka, AstraZeneca K.K., Osaka, Japan

Early diagnosis and active management can slow disease progression of CKD. However, diagnosis rate of CKD in stage 3a (G3a) based on eGFR is reported to be very low (around 10%) in a real-world setting. This study assessed the impact of urinary protein examination in combination with eGFR on the improvement of early diagnosis of CKD patients.


REAL-CKD is a hospital-based observational study using RWD database (Real World Data Co.,Ltd., Kyoto, Japan) between 2004-2021. Patients aged ≥18 years with two or more eGFR results of <90 mL/min/1.73m2 between 90-360 days apart were included. Patients with CKD diagnosis were defined as having an associated CKD diagnosis code any time in 12 months before or 3 months after the second eGFR measurement. Qualitative proteinuria such as urine albumin-to-creatinine ratio (UACR) and urine protein-to-creatinine ratio (UPCR) were utilized for KDIGO risk classification.


Of 788,059 eligible patients, qualitative urinary protein records necessary for KDIGO risk classification were available in 54,073 (6.9%) patients. There was no gender difference in the overall CKD population while in A3 category, male rate was high (60.2%). The most frequent comorbidities were diabetes (63.7%), hypertension (51.1%) and heart failure (22.3%) in KDIGO risk classified population. The CKD diagnosis rate increased from A1 towards A3, notably in G2 (A1: 14.5, A2: 24.9, A3: 47.5%) and G3a (A1: 26.2, A2: 36.2, A3: 56.5%) with the total diagnosis rate of 20.2% and 35.4%, respectively (Figure1).


While urinary protein examination in combination with eGFR increased early diagnosis rate of CKD, the examination rate was very low and a high proportion of the patients were still not diagnosed properly in the real-world clinical setting. Given recent development of CKD treatment strategies, there is a clear need to increase the early diagnosis rate to improve the clinical outcomes by proactively detecting progressive CKD patients.


  • Commercial Support