Image Credit: Scientific Frontline
Scientific Frontline: Extended "At a Glance" Summary
The Core Concept: A novel screening methodology that utilizes population-based distribution charts for estimated glomerular filtration rate (eGFR) to identify subtle abnormalities in kidney function before they reach conventional diagnostic thresholds.
Key Distinction/Mechanism: Unlike standard binary diagnostic thresholds (e.g., eGFR < 60), this method functions similarly to pediatric growth charts. It assesses a patient's kidney function against age- and sex-specific population norms, flagging individuals who fall into lower percentiles (e.g., below the 25th percentile) as high-risk, even if their absolute eGFR values appear within the "normal" range.
Origin/History: Developed by researchers at Karolinska Institutet and published in Kidney International on January 16, 2026. The study analyzed data from over 1.1 million adults in Stockholm between 2006 and 2021.
Branch of Science: Nephrology and Clinical Epidemiology.
Major Frameworks/Components:
- Percentile-Based Assessment: Establishes that individuals falling below the 25th percentile for their age/sex cohort face significantly higher risks of kidney failure.
- U-Shaped Mortality Curve: Identifies that both extremely low and extremely high eGFR percentiles are associated with increased mortality risk.
- Web-Based Calculator: A digital tool developed to help clinicians instantly compare individual patient data against the newly constructed population distributions.
- SCREAM Project: The research is part of the larger Stockholm CREAtinine Measurements project.
Why It Matters: This approach shifts the paradigm from late-stage diagnosis to primary prevention. By identifying patients with "seemingly normal" eGFR values who are actually statistically at risk (e.g., a 55-year-old with an eGFR of 80), clinicians can intervene years before significant organ failure occurs.
Subtle abnormalities in kidney function — even within the range considered normal — may help identify people at risk of developing chronic kidney disease. This is shown in a new study from Karolinska Institutet, published in Kidney International. The researchers have therefore developed a web-based tool that could aid in early detection and thus primary prevention.
“We were inspired by the growth and weight charts used in pediatrics, which intuitively help clinicians identify children at risk of obesity or undergrowth,” says the first author of the study, Yuanhang Yang, Postdoctoral Researcher at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet.
A web-based calculator
The researchers have made their eGFR distribution charts openly available to healthcare professionals and developed a web-based calculator, developed by PhD student Antoine Creon, that can help assess how a patient’s eGFR compares with population norms for their age.
The study included over 1.1 million adults in the region of Stockholm, covering roughly 80 per cent of the population aged between 40 and 100 years. Nearly seven million eGFR tests collected between 2006 and 2021 were used to construct age- and sex-specific distributions.
The findings show that departures from the median eGFR for one’s age and sex are associated with worse outcomes. Individuals with an eGFR below the 25th percentile had a markedly higher risk of developing kidney failure requiring dialysis or transplantation. Mortality also displayed a U-shaped relationship; both low and high percentile extremes were linked to increased risk of death.
Ability to act earlier
The study also illustrates this lack of awareness in healthcare, according to the researchers. Among those with a seemingly normal eGFR above 60 ml/min/1.73 m², but below the 25th percentile, only one fourth had received additional testing for urinary albumin, which is important for detecting early kidney damage.
“For example, consider a 55-year-old woman with an eGFR of 80. Most clinicians would not react to such a seemingly normal value. However, our charts show that this corresponds to the 10th percentile for women of that age — and that she has a three-fold higher risk of starting dialysis in the future. This signals an opportunity to act earlier,” says Juan Jesús Carrero, Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
Research Tool: eGFR Percentile Explorer
Funding: The study is part of the SCREAM project and has been funded by the Swedish Research Council, the Swedish Heart-Lung Foundation, Region Stockholm and the Swedish Kidney Foundation, among others. The researchers report no conflicts of interest related to the content of the study.
Published in journal: Kidney International
Authors: Yuanhang Yang, Antoine Creon, Andrew S. Levey, Anne-Laure Faucon, Aurora Caldinelli, Marie Evans, Arvid Sjölander, Alberto Ortiz, Edouard L. Fu1, and Juan Jesus Carrero
Source/Credit: Karolinska Institutet | Felicia Lindberg
Reference Number: med011626_01