Silent Decline: Early Detection of Subclinical Chronic Kidney Disease in Hypertensive Patients Using Novel Biomarkers

Hugo Moreau¹, Leon Zimmermann², Sophie Turner³

Abstract

Background:
Hypertension is a major risk factor for chronic kidney disease (CKD), yet many patients develop kidney damage before symptoms or conventional laboratory changes appear. Early detection could prevent irreversible renal decline.

Objective:
To assess the utility of novel biomarkers—serum cystatin C, urinary neutrophil gelatinase-associated lipocalin (uNGAL), and kidney injury molecule-1 (KIM-1)—in detecting subclinical CKD among hypertensive adults.

Methods:
A multicenter cross-sectional study was conducted across five hospitals in France between March 2022 and March 2024. A total of 1,026 hypertensive patients aged 35–70 years without known CKD were recruited. Standard renal function tests (creatinine, eGFR) and novel biomarkers were measured. Subclinical CKD was defined as elevated biomarkers with normal creatinine and eGFR >60 mL/min/1.73m². Logistic regression identified predictors of subclinical CKD.

Results:
Subclinical CKD was detected in 19.4% (n=199) of patients. Elevated cystatin C (>1.03 mg/L) showed the highest predictive value (AUC = 0.89, sensitivity = 84.2%, specificity = 80.5%). uNGAL and KIM-1 levels were significantly higher in the subclinical CKD group (p < 0.001). Independent predictors included systolic BP >150 mmHg (OR = 2.1, 95% CI: 1.5–3.0) and duration of hypertension >8 years (OR = 1.8, 95% CI: 1.3–2.6).

Conclusion:
Novel renal biomarkers can detect subclinical kidney injury in hypertensive patients before conventional parameters show impairment. Implementing biomarker screening in high-risk patients could significantly improve early CKD prevention strategies.