02 慢性腎臟病流行病學 診斷及惡化因子 042 042

044 044 048 053 053 054 056 059 066 079 079 079 080 082 086 101 043 043

02 D A CKD GFR albuminuria) CKD 4 4 1+ 5-8 C GFR 2+ 2-14-16 21 C GFR cystatin C 4 2+ 1-4 23,24 26 Chronic Kidney Disease CKD Kidney Disease Outcome Quality Initiative KDOQI 2002 1 CKD GFR 60 ml/min /1.73m 2 CKD GFR 2005 Kidney Disease Improving Global Outcome KDIGO CKD 2,3 KDIGO 2009 10 2012 KDIGO CKD 4 2012 KDIGO CKD GFR CKD 5-8 KDIGO GFR<60 ml/ min/1.73m 2 ACR 30 mg/g 053

Taiwan Chronic Kidney Disease Clinical Guidelines CKD AER 30 mg/24 ACR 30 mg/g 3 mg/mmol GFR GFR<60 ml/min/1.73m 2 GFR G3a G5 2002 KDOQI CKD GFR CKD CKD CKD CKD GFR GFR 5-8 KDIGO 2011 GFR CKD 9 2012 KDIGO GFR CGA CKD CKD GFR 3 GFR 30-60 ml/min/1.73m 2 G3a 45-59 ml/min/1.73m 2 G3b 30-44 ml/min/1.73m 2 CKD CKD GFR GFR GFR ml/min/1.73m 2 G1 90 054

02 CKD GFR G2 60-89 * G3a 45-59 G3b 30-44 G4 15-29 G5 <15 CKD GFR * egfr egfr<60 3~5 CKD G1 G2 CKD AER mg/24 h CKD ACR mg/mmol mg/g A1 <30 <3 <30 A2 30-300 3-30 30-300 * A3 >300 >30 >300 ** AER ACR - CKD * ** >2200 mg/24h [ACR>2220 mg/g >220 mg/mmol] GFR CKD CKD CKD GFR CKD GFR CKD 055

Taiwan Chronic Kidney Disease Clinical Guidelines GFR albuminuria CKD 2012KDIGO A1 A2 A3 <30 mg/g 30-300 mg/g >300 mg/g <3 mg/mmol 3-30 mg/mmol >30 mg/mmol G1 >=90 G2 60-89 GFR ( ml/min/1.73m 2 ) G3a 45-59 G3b 30-44 G4 15-29 G5 <=15 GFR<60 ml/min/1.73m 2 GFR G3a-G5 CKD CKD CKD CKD CKD inulin clearance GFR GFR 125 I-iothalamate 99m Tc- DTPA GFR 10,11 99m Tc-DTPA renal dynamic imaging 20 GFR GFR MDRD GFR 12 056

02 113 50% cystatin C 13.3 K cysteine 酶 Cystatin C GFR 13 GFR Cystatin C GFR 70 90 ml/min/m 2 GFR cystatin C GFR 24 GFR Ccr ml/min = Ucr x V / Scr x 1440 min Ucr mg/ dl Scr mg/dl V 24 ml GFR CKD trimethoprim cimetidine GFR GFR 2012 KDIGO egfr MDRD CKD-EPI MDRD 1999 1,628 GFR 40 ml/min/1.73m 2 CKD 125 I-iothalamate 14 2000 4-variable MDRD abbreviated MDRD GFR 2005 Levey 057

Taiwan Chronic Kidney Disease Clinical Guidelines 4-variable MDRD IDMS- MDRD 15 4-variable or abbreviated MDRD 186 Cr -1.154 age -0.203 (0.742, if female) (1.212, if African American) IDMS-MDRD 175 Cr -1.154 age -0.203 (0.742, if female) (1.212, if African American) MDRD egfr>60 ml/min/1.73m 2 Levey 1999-2006 125 I-iothalamate 8,254 5,504 CKD Epidemiology Collaboration CKD-EPI 2,750 16 3,896 IDMS-MDRD egfr>60 ml/min/1.73m 2 16 CKD-EPI GFR IDMS-MDRD 17 CKD-EPI MDRD CKD 18 KDIGO CKD-EPI GFR CKD-EPI MDRD CKD-EPI CKD 19,20 2014 MDRD CKD-EPI MDRD 1.309 x MDRD 0.912 CKD CKD-EPI 1.262 x CKD-EPI 0.914 21 egfr 1.73m 2 ml/min/1.73m 2 egfr<60 ml/min/1.73m 2 Stevens 2,980 CKD cystatin C 2008 CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C CKD-EPI CKD-EPI cystatin C CKD-EPI creatinine-cystatin C 22 2011 23 Inker 13 5,352 2012 CKD-EPI cystatin C 2012 CKD-EPI creatinine-cystatin C 1,119 2012 CKD GFR 60-89 ml/min/1.73m 2 creatinine-cystatin C creatinine cystatin C 16.9% CKD-EPI 058

02 45-59 ml/min/1.73m 2 60 ml/min/1.73m 2 24 Shlipak cystatin C creatinine 11 90,750 5 CKD 2,960 CKD-EPI 45-59 ml/min/1.73m 2 42% cystatin C 60 ml/min/1.73m 2 34% 80% ESRD cystatin C cystatin C creatinine egfr ESRD 25 egfr 4,26 KDIGO egfr 45 59 ml/min/1.73m 2 CKD - egfr cystatin C mg/dl cystatin C cystatin C- egfr ml/min/1.73m 2 B CKD 1-27 2+ 28 C 2+ 29-38 2-39 CKD B AKI CKD 2++ 40,41 B CKD 1+ 42 2+ 30,31,36,38, 43,44 2-45-47 059

Taiwan Chronic Kidney Disease Clinical Guidelines CKD CKD 12% GFR 48 CKD 24,492 6,895 28.2% CKD 26.5% 95% CI 17.9-35.1% 49 CKD / CKD 2013 CKD 50 2006 HUNT II 65,604 70.6% 20 CKD 3,069 egfr<60 ml/min/1.73m 2 CKD 4.7% 20.6 95% CI 20.0-21.2 CKD 28 CKD 2013 50 27 CKD CKD CKD ( ) 2003 23,534 CKD 20 143 CKD DM DM CKD Hazard Ratio HR 5.0 95% CI 3 10 DM HR 10.7 95% CI 6 19 29 060

02 2003 15,625 20 CKD 11% CKD 30-60 ml/min/1.73m 2 14.2% 3.7% 38 2006 UKPDS 5,102 albuminuria DM 15 DM CKD 1% microalbuminuria HR 1.08 95% CI 1.03 1.12 macroalbuminuria HR 1.10 95% CI 1.02 1.18 30 DM HR 1.25 95% CI 1.05 1.49 GFR 60 ml/min/1.73m 2 HR 1.255 95% CI 1.020 1.544 30 ( ) 2003 23,534 CKD 20 143 CKD ( 120 mmhg 80 mmhg ) CKD HR 2.5 95% CI 0.05-12.0 HR 3.0 95% CI 0.6-14.4 HR 3.8 95% CI 0.8-17.2 HR 6.3 95% CI 1.3-29.0 / HR 8.8 95% CI 1.8-43.0 HR 1.4 95% CI 0.2-12.1 3.3 95% CI 0.4-25.6 3.0 95% CI 0.4-22.2 5.7 95% CI 0.8-43.0 9.7 95% CI 1.2-75.6 29 2006 UKPDS 5,102 DM 15 CKD 10 mmhg HR 1.15 95% CI 1.11 1.20 HR 1.15 95% CI 1.07 1.24 GFR 60 ml/min/1.73m 2 HR 1.107 95% CI 1.06 1.16 HR 1.39 95% CI 1.23 1.57 30 061

Taiwan Chronic Kidney Disease Clinical Guidelines 2005 11,104 14 1,377 12.4% CKD CKD OR 1.5 31 ( ) 2006 UKPDS 5,102 DM 15 CKD HR 1.46 95% CI 1.23 1.73 HR 1.58 95% CI 1.16 2.15 30 2007 13,826 CKD 520 3.8% CKD 314 2.3% Odds Ratio, OR =1.70 95% CI 1.36-2.13 32 ( ) 1997 4,365 OR=1.5 95% CI 1.1-2.1 OR=1.9 95% CI 1.4-2.6 OR=2.1 95% CI 1.5-3.0 ESRD ESRD 33 ( ) 2000 12,728 2 mg/dl 1.8 mg/dl 0.4 mg/dl 2.9 191 5.1/ TG CKD Rate Ratio, RR 1.65 95% CI 1.1-2.5 HDL-C CKD RR 0.47 95% CI 0.3-0.8 LDL-C CKD 35 062

02 ( ) 2010 1998-2002 36,620 ESRD 25,843 ESRD 61 100 ESRD OR 1.47 95% CI 1.01-2.14 200 ESRD OR 5.82 95% CI 3.89-8.7 61 100 ESRD OR 1.60 95% CI 1.20-2.14 200 ESRD OR 1.94 95% CI 1.29-2.92 34 ( ) 2011 925 4.71 HR 1.91 95% CI 1.33 2.76 40 2011 9,425 4.8 ESRD HR 22.69 95% CI 12.08 42.60 CKD AKI ESRD HR 181.89 95% CI 100.27 329.95 CKD AKI ESRD HR 4.50 95% CI 2.43 8.35 41 ( ) 2003 15,625 20 CKD 11% 20-39 60 ml/min/1.73m 2 0.9% 40-59 1.2% >70 16% 38 2003 80 CKD >1.7 mg/dl 1,701 80 10,000 45 063

Taiwan Chronic Kidney Disease Clinical Guidelines 2006 UKPDS 5,102 15 CKD HR 1.02 95%CI 0.94 1.12 GFR 60 ml/ min/1.73m 2 HR 2.15 95% CI 1.98 2.34 HR 1.01 95% CI 0.97 1.06 30 ( ) 2003 9,082 189 ESRD BMI>35 RR 2.3 95%CI 1.1-4.9 36 2005 10,096 691 7% CKD GFR 60 ml/min/1.73m 2 NCEP-ATP3 CKD OR 1.43 95% CI 1.18-1.73 43 2005 11,104 14 1,377 12.4% CKD>26.6 kg/m 2 <22.7 kg/m 2 CKD OR 1.45 95% CI 1.19-1.76 10% CKD OR 1.24 95% CI 1.03-1.50 31 2006 UKPDS 5,102 15 CKD HR 1.010 95% CI 1.004-1.016 HR 1.016 95% CI 1.006 1.026 egfr 60 ml/ min/1.73m 2 HR HR=0.95 95% CI 0.94-0.96 30 2011 1,456 65 3.15 CKD OR 1.78 95% CI 1.19-2.47 CKD 44 064

02 2012 4,288 15% 5.40 208 4.9% GFR 60 ml/min/1.73m 2 CKD HR 1.42 95% CI 1.03-1.73 46 2013 1,035 HOMA 11.1% 8.99% CKD RR 1.7 95%CI 1.07-2.71 47 2011 CKD 11 30,146 CKD OR 1.55 95% CI 1.34-1.80 CKD OR 1.61 95% CI 1.29-2.01 OR 1.27 95% CI 1.11-1.46 HDL-C OR 1.23 95% CI 1.12-1.36 OR 1.19 95% CI 1.05-1.34 OR 1.14 95% CI 1.03-1.26 42 ( ) 2007 CKD 9.9% CKD OR 2.2 95% CI 1.4-3.5 39 ( ) 2003 23,534 CKD 20 143 CKD CKD HR 2.4 95% CI 1.5 4 HR 2.9 95% CI 1.7 5.0 29 2003 9,082 189 ESRD 20 CKD RR 2.9 95% CI 1.6 5.2 36 2006 UKPDS 5,102 15 CKD HR 1.20 95% CI 1.01 1.42 GFR 60 ml/ min/1.73m 2 HR 1.25 95% CI 1.03 1.52 30 065

Taiwan Chronic Kidney Disease Clinical Guidelines ( ) 2003 9,082 189 RR, RR=3.7 95% CI 1.0 14.2 RR 10.1 95% CI 2.5 41.8 CKD RR 36 2005 11,104 14 1,377 12.4% CKD CKD OR 31 ( ) 2013 993 CKD 1 mg/dl OR 1.42 95% CI 1.27-1.59 37 A proteinuria 20% Tamm-Horsfall mucoprotein immunoglobulin light chain beta2-microglobulin 066

02 150 30 150 proteinuria 30 300 microalbuminuria 300 macroalbuminuria 1 51 KDIGO CKD 4 ACR >=30 mg/g >=3 mg/mmol 1- / ACR PCR B B ACR CKD PCR PCR 2++ 52-54 2++ 51,55 C trace (+/-) 2-2+ 56-59 Good practice point Good practice point 067

Taiwan Chronic Kidney Disease Clinical Guidelines Dipstick 300 500 mg 60 mg/dl < 10 (+/-) (trace) 15 1+ 30 2+ 100 3+ 300 4+ > 1000 (1) 1992-1996 1,028 8,620 2+ 5,980 119 1.7 mg/dl 10 61 (2) Okinawa 3%, 57 [-] [+/-] [1+] [2+] [>= 3+] 17 >= 3+ 16% 2+ 7.1% 1+ 1.4% +/- 0.38% 58 (3) 60 62 068

02 (4) 1+ 59 (5) ACR 2+ GFR 45-59.9 ml/min/1.73m 2 GFR 2.16 ml/min1.73m 2 1+ GFR 30-44.9 ml/ min1.73m 2 GFR 0.51 ml/min1.73m 2 56 PCR (1) PCR 24 PCR likelihood ratios 0.2 PCR rule out 51 (2) PCR pre-eclampsia 55 ACR (3) PCR 24 54 ACR (1) 24 ACR 24 AER ACR odds ratio 45.8 ACR 24 52 (2) RR 4.8 RR 3.6 53 (3) ACR PCR 4 (4) ACR PCR 63 069

Taiwan Chronic Kidney Disease Clinical Guidelines (5) ACR>=30 mg/g >=3 mg/mmol 4,63 (6) AER PER 4 (7) 1- monoclonal SIGN 2008 KDIGO 2012 CKD CKD KDIGO 2012 SIGN 2008 dipstick : KDIGO 2012 ACR PCR AER PER (mg/g) < 30 30-300 > 300 (mg/mmol) < 3 3-30 > 30 (mg/g) < 150 150-500 > 500 (mg/mmol) < 15 15-50 > 50 (mg/24h) < 30 30-300 > 300 (mg/min) (mg/24h) < 150 150-500 > 500 (SIGN 2008) 1+~3+ : (1) ACR PCR 1g 2 x ACR = PCR 1 g 1.3 x ACR = PCR 300 mg/day 500 mg/day (2) PCR ACR 1 mg/mmol=10 mg/g 070

02 Hematuria 1. 3 / 2. 3. 64 4. 2+ 17 2.4 58 ( ) 1. The National Kidney Disease Education Program NKDEP of the National Institutes of Health NIH 2. egfr 60 ml/min/1.73m 2 ACR PCR 63 3. NKDEP 65 4. CKD NKDEP 65 ( ) calcineurin lithium GFR NSAID GFR 63 ( ) / GFR 071

Taiwan Chronic Kidney Disease Clinical Guidelines ( ) NICE 2008 CKD 63 GFR (good practice points) ml/min/1.73m 2 1 2 >= 60 3 30-59 4 15-29 3 5 <15 6 072

02 1. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. American journal of kidney diseases : the official journal of the National Kidney Foundation.39(2 Suppl 1):S1-266.(4) 2. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-2100.(4) 3. Eckardt KU, Berns JS, Rocco MV, Kasiske BL. Definition and classification of CKD: the debate should be about patient prognosis--a position statement from KDOQI and KDIGO. Am J Kidney Dis. 2009;53(6):915-920.(4) 4. KDIGO CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1 150.(4) 5. Astor BC, Matsushita K, Gansevoort RT, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011;79(12):1331-1340.(1+) 6. Gansevoort RT, Matsushita K, van der Velde M, et al. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int. 2011;80(1):93-104.(1+) 7. Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073-2081.(1+) 8. van der Velde M, Matsushita K, Coresh J, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79(12):1341-1352.(1+) 9. Tonelli M, Muntner P, Lloyd A, et al. Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: a cohort study. Ann Intern Med. 2011;154(1):12-21.(2+) 10. Blaufox MD, Aurell M, Bubeck B, et al. Report of the Radionuclides in Nephrourology Committee on renal clearance. J Nucl Med. 1996;37(11):1883-1890.(4) 11. Fleming JS, Zivanovic MA, Blake GM, Burniston M, Cosgriff PS. Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun. 2004;25(8):759-769.(4) 073

Taiwan Chronic Kidney Disease Clinical Guidelines 12. Ma YC, Zuo L, Zhang CL, Wang M, Wang RF, Wang HY. Comparison of 99mTc-DTPA renal dynamic imaging with modified MDRD equation for glomerular filtration rate estimation in Chinese patients in different stages of chronic kidney disease. Nephrol Dial Transplant. 2007;22(2):417-423.(2-) 13. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40(2):221-226.(1-) 14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-470.(2+) 15. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247-254.(2+) 16. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-612.(2+) 17. Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K. Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med. 2012;156(11):785-795, w-270, w-271, w-272, w-273, w-274, w-275, w-276, w-277, w-278.(2++) 18. Matsushita K, Mahmoodi BK, Woodward M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. Jama. 2012;307(18):1941-1951.(1-) 19. Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982-992.(2-) 20. Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S. Modification of the CKD epidemiology collaboration (CKD-EPI) equation for Japanese: accuracy and use for population estimates. Am J Kidney Dis. 2010;56(1):32-38.(2-) 21. Chen LI, Guh JY, Wu KD, et al. Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. PLoS One. 2014;9(6):e99645.(2-) 22. Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395-406.(2+) 074

02 23. Inker LA, Eckfeldt J, Levey AS, et al. Expressing the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) cystatin C equations for estimating GFR with standardized serum cystatin C values. Am J Kidney Dis. 2011;58(4):682-684.(2+) 24. Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367(1):20-29.(2+) 25. Shlipak MG, Matsushita K, Arnlov J, et al. Cystatin C versus creatinine in determining risk based on kidney function. N Engl J Med. 2013;369(10):932-943.(1+) 26. Stevens LA, Levey AS. Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol. 2009;20(11):2305-2313.(1-) 27. Wu HY, Huang JW, Peng YS, et al. Microalbuminuria screening for detecting chronic kidney disease in the general population: a systematic review. Ren Fail. 2013;35(5):607-614.(1-) 28. Hallan SI, Dahl K, Oien CM, et al. Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. Bmj. 2006;333(7577):1047.(2+) 29. Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J. Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol. 2003;14(11):2934-2941.(2+) 30. Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes. 2006;55(6):1832-1839.(2+) 31. Gelber RP, Kurth T, Kausz AT, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis. 2005;46(5):871-880.(2+) 32. Elsayed EF, Tighiouart H, Griffith J, et al. Cardiovascular disease and subsequent kidney disease. Arch Intern Med. 2007;167(11):1130-1136.(2+) 33. Freedman BI, Soucie JM, McClellan WM. Family history of end-stage renal disease among incident dialysis patients. J Am Soc Nephrol. 1997;8(12):1942-1945.(2+) 34. Lai MN, Lai JN, Chen PC, Hsieh SC, Hu FC, Wang JD. Risks of kidney failure associated with consumption of herbal products containing Mu Tong or Fangchi: a population-based case-control study. Am J Kidney Dis. 2010;55(3):507-518.(2+) 35. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ. Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int. 2000;58(1):293-301.(2+) 36. Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL. Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology. 2003;14(4):479-487.(2+) 075

Taiwan Chronic Kidney Disease Clinical Guidelines 37. Chang HY, Lee PH, Lei CC, et al. Hyperuricemia is an independent risk factor for new onset micro-albuminuria in a middle-aged and elderly population: a prospective cohort study in taiwan. PLoS One. 2013;8(4):e61450.(2+) 38. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41(1):1-12.(2+) 39. Guh JY, Chen HC, Tsai JF, Chuang LY. Herbal therapy is associated with the risk of CKD in adults not using analgesics in Taiwan. Am J Kidney Dis. 2007;49(5):626-633.(2-) 40. Wu VC, Huang TM, Wu PC, et al. Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery. PLoS One. 2012;7(1):e27687.(2++) 41. Wu VC, Huang TM, Lai CF, et al. Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int. 2011;80(11):1222-1230.(2++) 42. Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD. Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2011;6(10):2364-2373.(1+) 43. Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol. 2005;16(7):2134-2140.(2+) 44. Cheng HT, Huang JW, Chiang CK, Yen CJ, Hung KY, Wu KD. Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly. J Clin Endocrinol Metab. 2012;97(4):1268-1276.(2+) 45. Drey N, Roderick P, Mullee M, Rogerson M. A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis. 2003;42(4):677-684.(2-) 46. Yang T, Chu CH, Hsu CH, et al. Impact of metabolic syndrome on the incidence of chronic kidney disease: a Chinese cohort study. Nephrology (Carlton). 2012;17(6):532-538.(2-) 47. Chen S, Chen Y, Liu X, et al. Association of insulin resistance with chronic kidney disease in non-diabetic subjects with normal weight. PLoS One. 2013;8(9):e74058.(2-) 48. Wen CP, Cheng TY, Tsai MK, et al. All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet. 2008;371(9631):2173-2182.(2+) 076

02 49. Ryan TP, Sloand JA, Winters PC, Corsetti JP, Fisher SG. Chronic kidney disease prevalence and rate of diagnosis. Am J Med. 2007;120(11):981-986.(3) 50. Qaseem A, Hopkins RH, Jr., Sweet DE, Starkey M, Shekelle P. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(12):835-847.(2++) 51. Price CP, Newall RG, Boyd JC. Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clin Chem. 2005;51(9):1577-1586.(2++) 52. Ewald B, Attia J. Which test to detect microalbuminuria in diabetic patients? A systematic review. Aust Fam Physician. 2004;33(7):565-567, 571.(2++) 53. Newman DJ, Mattock MB, Dawnay AB, et al. Systematic review on urine albumin testing for early detection of diabetic complications. Health Technol Assess. 2005;9(30):iii-vi, xiii-163.(2++) 54. Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. Bmj. 1998;316(7130):504-509.(2++) 55. Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. Bmj. 2012;345:e4342.(2++) 56. Turin TC, James M, Ravani P, et al. Proteinuria and rate of change in kidney function in a community-based population. J Am Soc Nephrol. 2013;24(10):1661-1667.(2-) 57. Iseki K, Iseki C, Ikemiya Y, Fukiyama K. Risk of developing end-stage renal disease in a cohort of mass screening. Kidney Int. 1996;49(3):800-805.(2+) 58. Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int. 2003;63(4):1468-1474.(2+) 59. Tonelli M, Jose P, Curhan G, Sacks F, Braunwald E, Pfeffer M. Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial. Bmj. 2006;332(7555):1426.(2+) 60. Carroll MF, Temte JL. Proteinuria in adults: a diagnostic approach. Am Fam Physician. 2000;62(6):1333-1340.(3) 077

Taiwan Chronic Kidney Disease Clinical Guidelines 61. Lin CY, Sheng CC, Chen CH, Lin CC, Chou P. The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening. Pediatr Nephrol. 2000;14(10-11):953-959.(2+) 62. Boulware LE, Jaar BG, Tarver-Carr ME, Brancati FL, Powe NR. Screening for proteinuria in US adults: a cost-effectiveness analysis. Jama. 2003;290(23):3101-3114.(2++) 63. NICE clinical guideline 73: Early identification and management of chronic kidney disease in adults in primary and secondary care. 2008.(4) 64. Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol. 2003;14(7 Suppl 2):S131-138.(2+) 65. National Kidney Disease Education Program (NKDEP). http://www.nkdep.nih.gov/professionals/chronic_kidney_disease.htm (4) 078