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Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium
Open accessAbstract
Albuminuria is an under-recognized component of chronic kidney disease definition, staging, and prognosis. Guidelines, particularly for hypertension, conflict on recommendations for urine albumin-to-creatinine ratio (ACR) measurement. Separately among 1 344 594 adults with diabetes and 2 334 461 nondiabetic adults with hypertension from the chronic kidney disease Prognosis Consortium, we assessed ACR testing, estimated the prevalence and incidence of ACR ≥30 mg/g and developed risk models for ACR ≥30 mg/g. The ACR screening rate (cohort range) was 35.1% (12.3%–74.5%) in diabetes and 4.1% (1.3%–20.7%) in hypertension. Screening was largely unrelated to the predicted risk of prevalent albuminuria. The median prevalence of ACR ≥30 mg/g across cohorts was 32.1% in diabetes and 21.8% in hypertension. Higher systolic blood pressure was associated with a higher prevalence of albuminuria (odds ratio [95% CI] per 20 mm Hg in diabetes, 1.50 [1.42–1.60]; in hypertension, 1.36 [1.28–1.45]). The ratio of undetected (due to lack of screening) to detected ACR ≥30 mg/g was estimated at 1.8 in diabetes and 19.5 in hypertension. Among those with ACR <30 mg/g, the median 5-year incidence of ACR ≥30 mg/g across cohorts was 23.9% in diabetes and 21.7% in hypertension. Incident albuminuria was associated with initiation of renin-angiotensin-aldosterone system inhibitors (incidence-rate ratio [95% CI], diabetes 3.09 [2.71–3.53]; hypertension 2.87 [2.29–3.59]). In conclusion, despite similar risk of albuminuria to those with diabetes, ACR screening in patients with hypertension was low. Our findings suggest that regular albuminuria screening should be emphasized to enable early detection of chronic kidney disease and initiation of treatment with cardiovascular and renal benefits.
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“Screening using two tests with either being positive interpreted as a positive (leading to subsequent quantitative testing) increases the sensitivity to 97% but reduces the specificity to 83% (500,501).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [501]
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In the citing paper
“Pooling results from a bivariate randomeffects model gave sensitivity and specificity estimates of 76% (95% CI, 63-86%) and 93% (CI, 84-97%), respectively, for the semiquantitative test (501).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [501]
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In the citing paper
“The authors concluded that a negative semiquantitative POC test result does not rule out albuminuria, whereas quantitative POC testing meets required performance standards and can be used to rule out albuminuria.”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [501]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Sensitivity and specificity estimates for the quantitative test were 96% (95% CI, 78-99%) and 98% (95% CI, 93-99%), respectively.”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [501]
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Metadata
- Authors
- Shin, J.-I., Chang, A. R., Grams, M. E., Coresh, J., Ballew, S. H., Surapaneni, A., Matsushita, K., Bilo, H. J. G., Carrero, J. J., Chodick, G., Daratha, K. B., Jassal, S. K., Nadkarni, G. N., Nelson, R. G., Nowak, C., Stempniewicz, N., Sumida, K., Traynor, J. P., Woodward, M., Sang, Y., Gansevoort, R. T., Chalmers, J., Tuttle, K., Alicic, R., McPherson, S., Jones, C., Singh, G., Green, J., Kirchner, H. L., Shalev, V., Bottinger, E. P., Loos, R. J. F., Ellis, S. B., Cuddeback, J., Ciemins, E., Carbonara, E., Dunning, S., Knowler, W. C., Looker, H. C., Kieneker, L. M., Bakker, S. J. L., Hillege, H. L., van der Harst, P., Jassal, S. K., Bergstrom, J., Ix, J., Kovesdy, C. P., Potukuchi, P., Trevisan, M., Elinder, C. G., Wettermark, B., Ärnlöv, J., Mark, P. B., Thomson, P. C., Geddes, C. C., Landman, G. W. D., van Hateren, K. J. J., Kleefstra, N., Gutierrez, O., Konta, T., Levey, A. S., Polkinghorne, K., Schäffner, E., Chen, J., & Surapeneni, A.
- Affiliations
- Johns Hopkins University (US)
- Geisinger Medical Center (US)
- University Medical Center Groningen (NL)
- Karolinska Institutet (SE)
- Tel Aviv University (IL)
- Providence St. Joseph Health on behalf of CURE-CKD Investigators, Spokane, WA (K.B.D.)
- Icahn School of Medicine at Mount Sinai (US)
- National Institutes of Health (US)
- American Medical Group Association (US)
- University of Tennessee Health Science Center (US)
- Queen Elizabeth University Hospital (GB)
- ORCID
- Shin, Jung-Im
- Chang, Alex R.
- Grams, Morgan E.
- Coresh, Josef
- Ballew, Shoshana H.
- Surapaneni, Aditya
- Matsushita, Kunihiro
- Bilo, Henk J.G.
- Carrero, Juan J.
- Chodick, Gabriel
- Daratha, Kenn B.
- Nadkarni, Girish N.
- Nelson, Robert G.
- Nowak, Christoph
- Stempniewicz, Nikita
- Sumida, Keiichi
- Traynor, Jamie P.
- Woodward, Mark
- Sang, Yingying
- Gansevoort, Ron T.
- Chalmers, John
- Tuttle, Katherine
- Alicic, Radica
- McPherson, Sterling
- Jones, Cami
- Singh, Gurmukteshwar
- Green, Jamie
- Kirchner, H. Lester
- Shalev, Varda
- Loos, Ruth J.F.
- Ellis, Stephen B.
- Ciemins, Elizabeth
- Dunning, Stephan
- Knowler, William C.
- Looker, Helen C.
- Bakker, Stephan J.L.
- Hillege, Hans L.
- Ix, Joachim
- Kovesdy, Csaba P.
- Potukuchi, Praveen
- Trevisan, Marco
- Wettermark, Björn
- Ärnlöv, Johan
- Mark, Patrick B.
- Thomson, Peter C.
- Geddes, Colin C.
- Landman, Gijs W.D.
- Kleefstra, Nanne
- Konta, Tsuneo
- Levey, Andrew S.
- Polkinghorne, Kevan
- Venue
- Hypertension
- Published
- 2021-10
- Volume
- 78
- Issue
- 4
- Pages
- 1042-1052
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC8429211
- OpenAlex
- W3188495695
- Semantic Scholar
- 9fd2f82a888974bc1547c07692b4c2ec79ecb7a5
- Cited by
- 155
- References
- 29
- Citations by year
- 2026: 31 · 2025: 51 · 2024: 26 · 2023: 28 · 2022: 18 · 2021: 1
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Hypertension (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- National Heart, Lung, and Blood Institute (K24HL155861)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK121825, R01DK100446, R01DK115534, P30DK079626)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- albuminuria, albumin-creatinine ratio, chronic kidney disease, diabetes mellitus, prevalence, incidence, risk model, systolic blood pressure, renin-angiotensin-aldosterone system inhibitors, early detection
- MeSH terms
- Adult, Aged, Albuminuria, Creatinine, Diabetes Mellitus, Glomerular Filtration Rate, Humans, Hypertension, Middle Aged, Renal Insufficiency, Chronic
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