The Clinical Utility of SUDOSCAN in Chronic Kidney Disease in Chinese Patients with Type 2 Diabetes

PLoS One. 2015 Aug 13;10(8):e0134981. doi: 10.1371/journal.pone.0134981. eCollection 2015.

Abstract

There are gaps between recommendations on regular screening for diabetic kidney disease (DKD) and clinical practice especially in busy and low resource settings. SUDOSCAN (Impeto Medical, Paris, France) is a non-invasive technology for assessing sudomotor function using reverse iontophoresis and chronoamperometry which detects abnormal sweat gland function. Vasculopathy and neuropathy share common risk factors and we hypothesized that SUDOSCAN may be used to detect chronic kidney disease (CKD). Between 2012 and 2013, SUDOSCAN was performed in a consecutive cohort of 2833 Hong Kong Chinese adults with type 2 diabetes. Chronic kidney disease was defined as estimated glomerular filtration rate <60 ml/min/1.73m2. In this cross-sectional cohort (mean age 58.6±9.5 years, 55.7% male, median disease duration 8 [interquartile range 3-14] years), 5.8% had CKD. At a cut-off SUDOSCAN-DKD score of 53, the test had sensitivity of 76.7%, specificity of 63.4% and positive likelihood ratio of 2.1 to detect CKD. The area under receiver operating characteristic curve for CKD was 0.75 (95% confidence interval 0.72-0.79). Patients without CKD but low score had worse risk factors and complications than those with high score. We conclude that SUDOSCAN may be used to detect patients at risk of impaired renal function as part of a screening program in Chinese population, especially in outreach or low resource settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • China
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / physiopathology
  • Early Diagnosis
  • Female
  • Galvanic Skin Response
  • Humans
  • Male
  • Middle Aged
  • ROC Curve
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / physiopathology
  • Sweat Glands / physiopathology*

Grant support

The study was supported by a research grant by Impeto, Paris, France, and the Liao Wun Yuk Diabetes Research Memorial Fund under the Chinese University of Hong Kong. The Joint Asia Diabetes Evaluation program was partly supported by Merck Limited. Impeto, Paris, France, had input in study design, manuscript revision and decision to publish, but they had no role in data collection, data analysis, and data interpretation. The other funders including the Liao Wun Yuk Diabetes Research Memorial Fund and Merck Limited had no role in study design, data collection, data analysis, decision to publish, or preparation of the manuscript.