Key result
A targeted screening strategy based on the presence of at least one modifiable risk factor identified all subjects with macroalbuminuria and 64% of those with microalbuminuria, reducing false positives compared to unselective screening.
Why the study?
Does a targeted screening strategy based on clinical risk factors improve the identification of albuminuria compared to unselective screening in an apparently healthy population?
Cross-Sectional (n=1,191)
Does a targeted screening strategy based on clinical risk factors improve the identification of albuminuria compared to unselective screening in an apparently healthy population?
Absolute Event Rate: 7.4% vs 2.4%
p-value: p=<0.001
Screening for albuminuria based on the presence of potentially modifiable risk factors (elevated heart rate, blood pressure, or glucose) is more efficient than unselective screening in an apparently healthy population.
May support efficient albuminuria screening in healthy adults; leaves open prospective validation before practice change.
BACKGROUND: There remains debate about the screening strategies for albuminuria. This study evaluated whether a screening strategy in an apparently healthy population based on basic clinical and biochemical parameters could be more effective than a strategy where screening for albuminuria is performed unselectively. METHODOLOGY/PRINCIPAL FINDINGS: The Unreferred Renal Insufficiency (URI) Study is a cross-sectional study on the prevalence of metabolic risk factors in Belgian workers, volunteering to be screened during a routine yearly occupational check-up. Subjects (n = 295) with treated hypertension, known diabetes, treated dyslipidaemia, cardiovascular and renal disease were excluded. Among 1,191 apparently healthy subjects, 23% had unknown hypertension, 13% had impaired glucose tolerance, 15.4% had normoalbuminuria, 4.2% had microalbuminuria and 0.4% had macroalbuminuria. Subjects with resting heart rate ≥85 bpm, plasma glucose ≥5.6 mmol/L and blood pressure ≥140/90 mmHg were associated with albuminuria of any degree. A strategy where only subjects with at least one of these risk factors (n = 431) were screened for albuminuria, would identify all subjects with macroalbuminuria (5/5), 64% of those with microalbuminuria (32/50), and less than half of those with normoalbuminuria (81/183). An alternative strategy whereby subjects were first screened for presence of albuminuria, and additional cardiovascular risk factors were only measured in subjects positive for albuminuria (n = 238), would identify only 27% (118/431) of the subjects with additional and potentially modifiable cardiovascular risk factors. On the other hand, half of the subjects in this study with albuminuria (120/238, of which 102 had normoalbuminuria), had no additional cardiovascular risk factor at all. CONCLUSIONS: Screening an apparently healthy population directly for albuminuria will result in a high percentage of false positives, mostly measured in the normal range. Screening for microalbuminuria and macroalbuminuria based on presence of additional, potentially modifiable risk factors appears to be more beneficial. Trial registration 2006 NCT00365911.
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Tol et al. (2010) conducted a cross-sectional in Albuminuria (n=1,191). Targeted screening strategy based on clinical risk factors (resting heart rate ≥85 bpm, plasma glucose ≥5.6 mmol/L, blood pressure ≥140/90 mmHg) vs. Unselective screening for albuminuria was evaluated on Prevalence of microalbuminuria in subjects with at least one risk factor versus no risk factors (p=<0.001). A targeted screening strategy based on the presence of at least one modifiable risk factor identified all subjects with macroalbuminuria and 64% of those with microalbuminuria, reducing false positives compared to unselective screening.
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