Study-Detected Albuminuria Among US Adults With Hypertension, Diabetes, or Both Without Self-Reported Kidney Disease: A Contemporary NHANES Cross-Sectional Study

Chronic kidney disease awareness remains low, and urine albumin testing may be underused even among adults with established cardiometabolic risk. We evaluated the contemporary burden and distribution of albuminuria among United States adults with diabetes, hypertension, or both who did not report a history of kidney disease. This cross-sectional study used nationally representative data from the National Health and Nutrition Examination Survey, including the 2017–March 2020 prepandemic cycle and the August 2021–August 2023 cycle. The analytic cohort included nonpregnant adults aged 20 years or older with diabetes, hypertension, or both, after excluding those with a self-reported history of kidney disease or dialysis. Study-detected albuminuria was defined as a urinary albumin-to-creatinine ratio of at least 30 mg/g measured during the NHANES examination among participants without a self-reported history of kidney disease or dialysis; severe albuminuria was defined as a ratio of at least 300 mg/g. Survey-weighted prevalence estimates were calculated, and survey-weighted Poisson regression was used to estimate adjusted prevalence ratios. Among 6,671 high-risk adults without a self-reported history of kidney disease, 17.4% (95% CI, 16.4%–18.4%) had albuminuria and 2.7% had severe albuminuria. Albuminuria prevalence was 11.7% among adults with hypertension alone, 19.4% among those with diabetes alone, and 32.6% (95% CI, 30.0%–35.2%) among those with both hypertension and diabetes. Among participants with preserved estimated glomerular filtration rate of at least 60 mL/min/1.73 m², albuminuria prevalence was 15.3% overall and reached 30.7% (95% CI, 27.7%–33.7%) among adults with both conditions. In the primary multiply imputed analysis, diabetes alone and both hypertension and diabetes were associated with higher albuminuria prevalence than hypertension alone, with adjusted prevalence ratios of 1.60 (95% CI, 1.34–1.93) and 2.38 (95% CI, 2.07–2.74), respectively. Among United States adults with diabetes, hypertension, or both who did not report a history of kidney disease, albuminuria was common, particularly among those with both conditions. These findings provide a contemporary estimate of study-detected albuminuria burden among adults with hypertension, diabetes, or both. When considered alongside prior evidence of underuse of urine albumin testing, the substantial burden observed in these high-risk groups highlights an opportunity to strengthen kidney-risk assessment, while abnormal UACR findings require confirmation before persistent albuminuria or CKD is established.