Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement

Johnson, David W.; Jones, Graham; Mathew, Timothy H.; Ludlow, Marie; Chadban, Stephen J; Usherwood, Tim; Polkinghorne, Kevan R.; Colagiuri, Stephen; Jerums, George; MacIsaac, Richard J; Martin, Helen

doi:10.5694/mja11.11468

Cited by 175 publications

(94 citation statements)

References 51 publications

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“…Currently, universal thresholds are used almost exclusively, while several prior studies and strategies suggested gender-specific cut-off points to define pathological UAE. It has also been suggested that albuminuria may be less important in women, primarily due to lower muscle mass and urinary creatinine excretion with potential overestimation of ACR [12,13,30,31,32]. Our findings partly contradict these views and rather strengthen the foundations of newer guidelines, such as KDIGO [15], using universal ACR thresholds for CKD diagnosis and classification and thereby simplifying daily clinical practice.…”

Section: Discussioncontrasting

confidence: 56%

“…Furthermore, day-to-day variability in urinary albumin excretion (UAE) can be substantial (25-50%), reflecting both biological variability and changes in disease status [9,10]. Urinary creatinine excretion is also lower in women [11]; therefore, some previous guidelines suggest different albumin-creatinine ratio (ACR) cut-off values for diabetic men and women [12,13,14]. The scientific basis for using gender-specific cut-offs, particularly for non-diabetic individuals, has been weak, and most guidelines, including the 2012 KDIGO guidelines on Chronic Kidney Disease (CKD) diagnosis and classification, therefore use universal thresholds [15].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Hatlen

Romundstad²,

Salvesen³

et al. 2016

Nephron

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Background: The association between albuminuria and coronary heart disease (CHD) is well-known, but uncertainties related to day-to-day variability and effect modification of gender complicate the risk assessment process. This study evaluates the associations of CHD with albuminuria level in men and women based on the number of urine samples. Methods: Nine thousand one hundred and fifty-eight adults provided 3 urine samples and were followed for 14 years in the population-based HUNT-2 cohort study. The association of myocardial infarction or coronary death with different albumin-creatinine ratio (ACR) cut-offs, based on gender and number of positive ACRs, were estimated by hazard ratios (HRs) and adjusted for by Framingham variables. Results: Associations between ACR and CHD were similar in men and women. For example, HRs for moderately increased (3.0≤ ACR ≤30.0 mg/mmol) vs. normal albuminuria (ACR <1.0 mg/mmol) were 1.40 (95% CI 1.27-2.03) and 1.61 (95% CI 1.15-1.71) respectively, (p_sex-equality = 0.3). However, median intra-individual day-to-day ACR coefficient of variation was 22.4% in women vs. 17.5% in men (p < 0.001). Two or 3 positive ACRs were required to establish a significant association with CHD at levels below 4.0 mg/mmol in women, while one positive ACR implied a significant association at all levels in men. Based on receiver-operating-characteristics curves, the Youden index suggested possible equal cut-offs for women (1.12 mg/mmol) and men (0.88 mg/mmol), p = 0.06. Conclusions: There were no significant gender differences in the association between albuminuria and coronary events. However, women had increased intra-individual albuminuria variability compared to men, necessitating several positive urine samples if mildly increased albuminuria is used in coronary risk evaluation.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Hatlen

Romundstad²,

Salvesen³

et al. 2016

Nephron

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“…(18) This method of classifying albuminuria reduces costs and allows for easier comparison in future studies. Johnson et al (13) likewise recommended that if the initial urine ACR test was negative, repeat testing was not required until the next recommended testing interval. However, the criteria for diagnosis of albuminuria in the current study did not strictly adhere to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…(12) The proteincreatinine ratio (PCR) test may be used in place of the ACR test if ACR is more than 30 mg/mmoL; this is because the relationship between ACR and PCR is non-linear, and higher ACRs could not adequately predict the amount of 24-hour urinary protein. (13) Since the switch from the micral test to the quantitative urine ACR test for diagnosis of microalbuminuria, all doctors working in the polyclinic had been briefed and reminded to offer a second urine test if the first urine sample showed ACR > 2.5 mg/mmoL for male patients and > 3.5 mg/mmoL for female patients.…”

Section: Methodsmentioning

confidence: 99%

The prevalence of albuminuria among diabetic patients in a primary care setting in Singapore

Lee¹,

Tang²

2015

smedj

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INTRODUCTIONMicroalbuminuria is an early sign of kidney damage. The prevalence of microalbuminuria in Singapore has been reported to be 36.0%-48.5%. However, the prevalence of microalbuminuria reported in these studies was determined with one urine sample using a qualitative urine test. The aim of this study was to determine the prevalence of micro-and macroalbuminuria using a more stringent criterion of two positive quantitative urine albumin-creatinine ratio (ACR) tests. METHODSWe conducted a cross-sectional study of patients with type 2 diabetes mellitus (T2DM) who were followed up at a primary care clinic in Singapore. Patients were diagnosed to have albuminuria if they had two positive ACR tests within a seven-month period. RESULTSA total of 786 patients with T2DM met the study's inclusion criteria. 55.7% were already on an angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB). The prevalence rates of micro-and macroalbuminuria were 14.2% and 5.7%, respectively. Patients with albuminuria were more likely to have hypertension (odds ratio [OR] 3.47, 95% confidence interval [CI] 1.55-7.80). Diabetics with poorer diabetic control (OR 1.88, 95% CI 1.26-2.79), and higher systolic (OR 1.69, 95% CI 1.14-2.49) and diastolic (OR 1.96, 95% CI, 1.20 to 3.22) blood pressures were more likely to have albuminuria. CONCLUSIONIn the present study, the prevalence of microalbuminuria is significantly lower than that previously reported in Singapore. The presence of hypertension, poor diabetic control and suboptimal blood pressure control are possible risk factors for albuminuria in patients with T2DM.

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“…Recent guidelines recommend measuring albuminuria in all CKD patients based on the prognostic importance of albuminuria for kidney disease outcomes, as well as for cardiovascular disease and mortality [5][6][7]. Although 24-h urine albuminuria is the gold standard for quantitative measurement, the preferred method for assessing albuminuria in both diabetic and non-diabetic patients is urine albumin-to-creatinine ratio (ACR) measurement in a first-void spot urine specimen [8,9]. Considering the cost required for immunoassays of albuminuria, however, whether testing for both albuminuria and proteinuria is necessary among CKD patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Urinary Indices for Albuminuria and Proteinuria in Patients with Chronic Kidney Disease

Hong

Oh²,

Park³

et al. 2016

Kidney Blood Press Res

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Background/Aims: Either protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) can be adopted for estimation of proteinuria in patients with chronic kidney disease (CKD). Estimated protein excretion rate (ePER) and estimated albumin excretion rate (eAER) may be superior to ACR and PCR. Reports show that urine albumin-to-protein ratio (APR) may be useful in detecting tubular proteinuria, but should be compared with urine protein electrophoresis (PEP). Methods: Both 24-h urine and spot urine were collected from 77 stable CKD patients for measurement of albumin, protein, and creatinine, and PEP. Based on MDRD and CKD-EPI equations, ePER_MDRD, ePER_CKD-EPI, eAER_MDRD and eAER_CKD-EPI were calculated to estimate daily proteinuria and albuminuria. Glomerular CKD was defined by clinical and/or pathological evidence. Results: ACR correlated significantly with PCR. However, microalbuminuria was present in patients without pathologic proteinuria. Twenty-four-hour urine albumin correlated better with eAER_MDRD and eAER_CKD-EPI than ACR, and 24-h urine protein correlated better with ePER_MDRD and ePER_CKD-EPI than PCR. APR significantly but not well correlated with the albumin fraction in urine PEP. The albumin fraction obtained from urine PEP was significantly higher in patients with glomerulopathy than those with non-glomerular CKD, whereas there were no differences in APR between groups. In contrast with APR, the albumin fraction in urine PEP was independently associated with glomerular CKD. Conclusions: Both PCR and ACR are useful in evaluation of proteinuria. In quantifying daily proteinuria and albuminuria, ePER and eAER are superior to PCR and ACR, respectively. Compared with APR, urine PEP is more useful in diagnosing glomerular proteinuria.

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Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement

Cited by 175 publications

References 51 publications

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

The prevalence of albuminuria among diabetic patients in a primary care setting in Singapore

Evaluation of Urinary Indices for Albuminuria and Proteinuria in Patients with Chronic Kidney Disease

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