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Abstract: PO2354

Albuminuria Testing in Hypertension and Diabetes

Session Information

Category: CKD (Non-Dialysis)

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


  • 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

  • Chronic Kidney Disease Prognosis Consortium

Albuminuria is an under-recognized component of chronic kidney disease (CKD) definition, staging, and prognosis. Despite significant advances in therapies for patients with albuminuria, guidelines, particularly for hypertension, conflict on recommendations for urine albumin-to-creatinine ratio (ACR) measurement.


We separately analyzed 1,305,841 adults with diabetes in 25 cohorts and 2,111,587 non-diabetic adults with hypertension in 21 cohorts from the CKD Prognosis Consortium. We estimated ACR testing rates during a 2-year window, and developed and utilized risk prediction models for prevalent albuminuria (ACR ≥30 mg/g) to determine if high-risk patients for albuminuria are more likely to be tested and to estimate the burden of undetected albuminuria.


Overall, the ACR testing rate was 35.3% in diabetes and 4.1% in hypertension. Among patients with diabetes, testing rates varied greatly across the different health systems and were largely unrelated to the predicted risk of prevalent albuminuria (Figure A). Among patients with hypertension, testing rates were low and also unrelated to the predicted risk of prevalent albuminuria (Figure B). The estimated ratio (cohort range) of undetected (due to lack of testing) to detected prevalent albuminuria was 1.8 (0.2-7.6) in diabetes and 19.5 (0.8-78.3) in hypertension.


Real-world ACR testing is low, particularly among non-diabetic patients with hypertension, and testing is unrelated to predicted risk. There are large swaths of the population with diabetes or hypertension with undiagnosed CKD, suggesting that regular albuminuria screening should be emphasized for early detection of CKD and appropriate initiation of treatment with cardiovascular and kidney benefits.


  • NIDDK Support