Results from the Towards HOMe-based Albuminuria Screening (THOMAS) study were recently published in The Lancet. The Dutch researchers showed that early detection of chronic kidney damage (CNS) with a simple home urine test gives good results, especially when a traditional method with a urine sample by post is used.
Because increased albuminuria is one of the strongest predictors of progressive CNS and cardiovascular disease, researchers from the UMCG and the Amphia Hospital evaluated 2 methods for screening at home for albuminuria to detect CNS at an early stage. They did this in the THOMAS study, in which they randomized 15,074 Dutch people between the ages of 45 and 80 to screening with a urine sample (UCD) that was sent by post to a laboratory for determination of the albumin-creatinine ratio (ACR) or with a smartphone. app that measures ACR with a dipstick method.
The participation rate was significantly higher for the UCD method (59.4%) than for the smartphone method (44.3%; p < 0.0001). Moreover, the UCD method was able to detect albuminuria more accurately, because the specificity of the smartphone method turned out to be too low at 67.9%. An abnormal ACR was found during home screening in 150 (3.3%) of the participants in the UCD group. They were invited for an extensive screening for CNS and cardiovascular risk factors and 124 (82.7%) of them had this follow-up examination performed. Ultimately, 111 participants (89.5%) were found to have abnormalities that had not yet been diagnosed but were easily treatable, namely albuminuria (62.1%), hypertension (35.5%), hypercholesterolemia (24.2%) and reduced renal function (21.8%). These participants were referred to their own GP for further treatment.
The researchers conclude that the UCD method is promising for early detection of kidney damage, so that treatment can be started in time to prevent progressive loss of kidney function and cardiovascular disease.
Mil D van, Kieneker LM, Evers-Roeten B, et al. Participation rate and yield of two home-based screening methods to detect increased albuminuria in the general population in the Netherlands (THOMAS): a prospective, randomized, open-label implementation study. Lancet 2023;402:1052-64.