Sensitive and specific biomarkers are needed to provide better biologic insight into the risk of incident and progressive CKD. However, studies have been limited by sample size and design heterogeneity.

In this assessment of the prognostic value of preclinical plasma and urine biomarkers for CKD outcomes, we searched Embase (Ovid), MEDLINE ALL (Ovid), and Scopus up to November 30, 2020, for studies exploring the association between baseline kidney biomarkers and CKD outcomes (incident CKD, CKD progression, or incident ESKD). We used random-effects meta-analysis.

After screening 26,456 abstracts and 352 full-text articles, we included 129 studies in the meta-analysis for the most frequently studied plasma biomarkers (TNFR1, FGF23, TNFR2, KIM-1, suPAR, and others) and urine biomarkers (KIM-1, NGAL, and others). For the most frequently studied plasma biomarkers, pooled RRs for CKD outcomes were 2.17 (95% confidence interval [95% CI], 1.91 to 2.47) for TNFR1 (31 studies); 1.21 (95% CI, 1.15 to 1.28) for FGF-23 (30 studies); 2.07 (95% CI, 1.82 to 2.34) for TNFR2 (23 studies); 1.51 (95% CI, 1.38 to 1.66) for KIM-1 (18 studies); and 1.42 (95% CI, 1.30 to 1.55) for suPAR (12 studies). For the most frequently studied urine biomarkers, pooled RRs were 1.10 (95% CI, 1.05 to 1.16) for KIM-1 (19 studies) and 1.12 (95% CI, 1.06 to 1.19) for NGAL (19 studies).

Studies of preclinical biomarkers for CKD outcomes have considerable heterogeneity across study cohorts and designs, limiting comparisons of prognostic performance across studies. Plasma TNFR1, FGF23, TNFR2, KIM-1, and suPAR were among the most frequently investigated in the setting of CKD outcomes.

需要敏感和特异的生物标志物来更好地了解事件和进展性 CKD 的风险。然而，研究受到样本量和设计异质性的限制。

在评估临床前血浆和尿液生物标志物对 CKD 结局的预后价值时，我们检索了截至 2020 年 11 月 30 日的 Embase (Ovid)、MEDLINE ALL (Ovid) 和 Scopus，以寻找探索基线肾脏生物标志物与 CKD 之间关联的研究结果（CKD 事件、CKD 进展或 ESKD 事件）。我们使用随机效应荟萃分析。

在筛选了 26,456 篇摘要和 352 篇全文文章后，我们将 129 项研究纳入了最常研究的血浆生物标志物（TNFR1、FGF23、TNFR2、KIM-1、suPAR 等）和尿液生物标志物（KIM-1）的荟萃分析中。 、NGAL 等）。对于最常研究的血浆生物标志物，TNFR1（31 项研究）的 CKD 结局的汇总 RR 为 2.17（95% 置信区间 [95% CI]，1.91 至 2.47）；FGF-23（30 项研究）为 1.21（95% CI，1.15 至 1.28）；TNFR2 为 2.07（95% CI，1.82 至 2.34）（23 项研究）；KIM-1（18 项研究）为 1.51（95% CI，1.38 至 1.66）；suPAR 为 1.42（95% CI，1.30 至 1.55）（12 项研究）。对于最常研究的尿液生物标志物，KIM-1（19 项研究）的汇总 RR 为 1.10（95% CI，1.05 至 1.16），NGAL（19 项研究）的汇总 RR 为 1.12（95% CI，1.06 至 1.19）。

CKD 结局的临床前生物标志物研究在不同研究队列和设计之间具有相当大的异质性，限制了不同研究之间预后表现的比较。血浆 TNFR1、FGF23、TNFR2、KIM-1 和 suPAR 是 CKD 结局中最常研究的指标之一。