Jung-Im Shin, Alex R Chang, Morgan E Grams, Josef Coresh, Shoshana H Ballew, Aditya Surapaneni, Kunihiro Matsushita, Henk JG Bilo, Juan J Carrero, Gabriel Chodick, Kenn B Daratha, Simerjot K Jassal, Girish N Nadkarni, Robert G Nelson, Christoph Nowak, Nikita Stempniewicz, Keiichi Sumida, Jamie P Traynor, Mark Woodward, Yingying Sang and Ron T Gansevoort
Albuminuria, commonly measured as urine albumin-to-creatinine ratio (ACR), is an under-recognized component of chronic kidney disease (CKD) definition, staging and prognosis. ACR levels of ≥30 mg/g defines CKD stage A2+. In this study, the authors used individual-participant data from multinational cohorts from the CKD Prognosis Consortium to: 1) estimate ACR testing rates, and determine if high-risk patients for albuminuria are more likely to be tested; 2) estimate the prevalence of ACR ≥30 mg/g; 3) estimate the 5-year incidence of ACR ≥30 mg/g; and 4) develop and utilise risk prediction models for ACR ≥30 mg/g to estimate the burden of undetected albuminuria in participants with diabetes and hypertension but no diabetes.
The group reported that the ACR screening rate was 35.1% in people with diabetes and 4.1% in people with hypertension. Additionally, the median prevalence of ACR ≥30 mg/g across cohorts was 32.1% and 21.8% in the diabetes and hypertension group, respectively. Higher systolic blood pressure was also found to be associated with a higher prevalence of albuminuria. The study also demonstrated that amongst those with an ACR of <30 mg/g, the median 5-year incidence of ACR ≥30 mg/g across cohorts was 23.9% in people with diabetes and 21.7% in people with hypertension.
The authors conclude that despite similar risk of albuminuria to those with diabetes, ACR screening in patients with hypertension was low. They also emphasize the importance of regular albuminuria screening to enable early detection of CKD and initiation of treatment with cardiovascular and renal benefits.
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