April 15, 2006
Test Predicts Kidney Failure Years In Advance

Imagine you could be told two or three or four decades in advance what you are going to die from. Imagine a doctor could tell you that you will die from pancreatic failure 20 years from now barring the development of stem cell therapies or bioengineering technologies for growth of replacement organs. Would it change your attitude toward the urgency of medical research?

I've been predicting for some years that advances in biomedical testing will lead to the ability to predict occurrence of many diseases decades in advance and that this will change public attitudes toward biomedical research funding. A recent report shows another example of how testing can increase accuracy of prediction for disease occurrence. A urine test can identify people of very high risk of kidney disease over a 25 year period.

Routine blood and urine tests may help to predict the risk of end-stage renal disease (ESRD) developing between middle age and old age, reports a study in the May Journal of the American Society of Nephrology.

Abnormal results on the urine "dipstick" test, which detects protein in urine, and a blood test to estimate kidney function can identify patients at increased risk of ESRD—permanent loss of kidney function requiring dialysis or transplantation, according to the study by Dr. Areef Ishani of Minneapolis Veterans Affairs Medical Center and colleagues.

Would your willingness to repeatedly write and phone your elected representatives to ask for increased funding to grow replacement kidneys go up by much if someone could tell you that your kidneys are going to fail 20 years from now?

Think about it this way: Most people who are going to die from kidney failure or lung failure, or other organ failure spend the vast bulk of their lives not knowing exactly which organ or disease is going to do them in or when it will happen. So their support for biomedical research remains diffuse and weak. But if everyone knew what was going to kill them then everyone would have a much more clearly defined stake in the advance of biomedical science and biotechnology.

The higher the test result the higher the predicted risk of eventual kidney failure.

Over 25 years, 1.7 percent of the men developed ESRD or died of kidney disease. On the dipstick test, men who had more than a trace amount of protein in their urine in middle age were at triple the risk of ESRD at follow-up. For those with a stronger positive result, ESRD risk was more than 15 times higher than in men with a normal dipstick result.

The estimated glomerular filtration rate (eGFR)—a rough estimate of kidney function, based on a blood test—also predicted long-term ESRD risk. When the eGFR was abnormally low, risk of eGFR was more than doubled.

The risk of ESRD was especially high when both the dipstick test and eGFR were abnormal-—41 times higher than in men with normal results on both tests. Another routine blood test, the hematocrit level, was unrelated to ESRD risk.

Those people who had 41 times the risk of kidney failure probably had much more than a 50% chance of kidney failure.

Additional factors contribute to the risk of kidney failure.

Several other factors predicted ESRD risk, including age, smoking, blood pressure, low levels of high-density lipoprotein ("good") cholesterol, and blood sugar (glucose) level. Many risk factors for kidney disease are the same as those for heart disease.

Throw in future cheap genetic tests and some more blood and urine tests. Then the accuracy of calculations for risks of death from kidney failure will become even more exact. Ditto for predictions of failures of other organs and body parts.

The ability to predict what is going to kill you will not make each individual support research only on a single disease. People will also find out what is going to kill their parents, their best friends, their kids, their spouses, and acquaintances. Also, people are going to find out what would kill them if their first killer doesn't do it. "Well Bill, your heart's going to give out 15 to 20 years from now and then your kidneys a few years later and then your liver is going to be shot". Suddenly you'll have a laundry list of things you want cures for.

Plus, a lot of chronic diseases don't kill you but are mighty inconvenient and some are quite painful. Suppose teenagers can be told they're at high risk of seborrhea or Crohn's Disease or arthritis or several other diseases that won't kill them but will be with them for decades. Many of those medical problems you start accumulating in your teens, 20s, 30s, and 40s will become predictable to varying extents. Therefore in the future where tests can more accurately predict onset of a large range of diseases even teens will find more reasons to support biomedical research.

Advances in medical tests that increases disease prediction accuracy will create larger interest groups in support of development of cures for all the diseases whose occurrence can be more accurately predicted long in advance of clinical onset. Since advances in testing are happening and will continue to happen for decades to come I'm predicting a growth in the size of interest groups in support of the development of stem cell research, gene therapy, growth of replacement organs, and other cures for diseases. This trend will accelerate the development of treatments that can reverse aging entirely.

Share |      Randall Parker, 2006 April 15 12:01 PM  Aging Studies

Joshua Allen said at April 15, 2006 7:30 PM:

Now, how do you get your doctor to give you this test? I have been asking my doc for diagnostic tests every 6 months, and he generally takes the attitude of "I'll tell you if I think you need it". I have no problem paying.

FishEpid said at April 16, 2006 2:32 PM:

Most important - specifically how does one prevent or slow the course once diagnosed?

Joshua Allen said at April 16, 2006 5:23 PM:

Spend 25 years saving up your money to buy a kidney

KidneyNotes said at April 16, 2006 9:29 PM:

While the study does identify risk factors (protein in the urine and decreased kidney function) for future kidney failure, it doesn't argue that screening the entire population for these risks is necessarily cost-effective, and therefore the study is unlikely to change current guidelines, which are *not* in favor of screening everyone with these tests. A previous study in JAMA suggests that the cost per year of life saved with screening is > $200,000, a level usually not considered justifiable. However, screening high risk groups at particularly high risk for kidney failure, like those with high blood pressure, would be a more cost-effective solution.

rsilvetz said at April 16, 2006 10:41 PM:

Well -- If you google up BMP-7 (formerly known as OP-1) you will find a cytokine that in 1996 was identified to powerfully regenerate kidneys. Our extraordinarily dysfunctional pharma system has been unable to get thru pre-clinical tho we have endless rats and rodents experiments that have shown without a shadow of doubt how well this cytokine works.

Thru my grapevine in pharma I hear that the Israeli, fed up with waiting, may go the BMP-7 route alone. We shall see.

Randall Parker said at April 17, 2006 4:45 PM:


I'm thinking about the future when microfluidic devices will make possible cheap rapid in-office tests for hundreds or even thousands of compounds in the blood. People will find out their risks from blood and DNA tests and therefore they will find out that they face very high risks of death from specific diseases and disorders.

Also, those tests that become cheap will become entry doors to identify specific risks that warrant more expensive tests.

Once most people get told the specific risks they have it seems to me the size of interest groups for each disease will become much larger.

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