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Kidney Week

Abstract: PO0505

Albuminuria Testing and Prevalence and Incidence of Elevated Albuminuria

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Shin, Jung-Im, CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Chang, Alex R., CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Sang, Yingying, CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Gansevoort, Ron T., CKD Prognosis Consortium, Baltimore, Maryland, United States

Group or Team Name

  • CKD Prognosis Consortium
Background

Guidelines recommend an annual evaluation of urine albumin creatinine ratio (ACR) in patients with diabetes (DM) or hypertension (HTN) for early identification and close monitoring of kidney damage. The aim of this study was to inform ACR testing strategies by 1) evaluating the frequency of ACR testing, 2) determining the prevalence and incidence of ACR≥30 mg/g, and 3) developing and validating a risk prediction model for incident ACR≥30 mg/g.

Methods

We analyzed 28 cohorts from the CKD Prognosis Consortium including 1,909,350 persons with DM or HTN from 5 countries. Analysis was performed separately for persons with DM and those with HTN but without DM. We selected a two-year baseline period for administrative cohorts and used the baseline visit for research cohorts to assess frequency of testing and prevalence of a single ACR≥30 mg/g. Confirmed incident ACR≥30 mg/g (elevated twice) was assessed 5 years after baseline in those with baseline ACR<30 mg/g. Development of prediction models for incident ACR≥30 mg/g used logistic regression and age, sex, baseline systolic blood pressure, HTN and DM medication use, coronary heart disease, heart failure, BMI, A1c, and eGFR as covariates. Models were validated in 5 DM cohorts and 4 HTN only cohorts.

Results

The median frequency of ACR testing across administrative cohorts was 48.9% (IQI, 32.5-58.3%) and 4.3% (IQI, 3.2-7.1%) in DM and HTN only. Among those tested at baseline, the median prevalence of ACR≥30 mg/g was 32.7% (IQI, 28.4-37.0%) and 21.9% (IQI, 18.6-29.6%) in DM and HTN only. Among 107,754 persons with DM and 15,676 persons with HTN only who had baseline ACR<30 mg/g, the median incidence of ACR≥30 mg/g at 5 years was 23.3% (IQI, 18.6-28.5%) and 21.7% (IQI, 15.7-26.3%) in DM and HTN only. Risk prediction models for 5 year incidence of ACR≥30 mg/g had only modest accuracy in DM (median C statistic: development cohorts 0.629, IQI: 0.600-0.655; validation cohorts 0.635, IQI: 0.619-0.641) and in HTN only (median C statistic: development cohorts 0.649, IQI: 0.621-0.695; validation cohorts 0.663, IQI: 0.638-0.671).

Conclusion

ACR testing in DM or HTN is low in clinical practice. The risk prediction models for incident ACR≥30 mg/g performed only modestly, suggesting focused efforts based on risk stratification may not be a viable strategy. Universal albuminuria testing for individuals with DM or HTN is likely necessary.

Funding

  • NIDDK Support