The urine dipstick test had poor sensitivity (43.6%) and a high false-discovery rate for detecting albuminuria (ACR ≥30 mg/g) compared to the albumin:creatinine ratio.
Cross-Sectional (n=20,759)
Does urine albumin:creatinine ratio (ACR) improve chronic kidney disease screening accuracy and risk categorization compared to urine dipstick testing in the general adult population?
Urine ACR is superior to dipstick testing for CKD screening, offering better sensitivity and more accurate risk categorization linked to quality of life.
Absolute Event Rate: 7.2% vs 9.1%
Chronic kidney disease (CKD) is usually diagnosed using the estimated glomerular filtration rate (eGFR) or kidney damage markers. The urine dipstick test is a widely used screening tool for albuminuria, a CKD marker. Although the urine albumin:creatinine ratio (ACR) has advantages over the dipstick test in sensitivity and quantification of levels, the two methods have not been compared in the general population. A total of 20,759 adults with urinalysis data in the Korea National Health and Nutrition Examination Survey 2011-2014 were examined. CKD risk categories were created using a combination of eGFR and albuminuria. Albuminuria was defined using an ACR cutoff of 30 mg/g or 300 mg/g and a urine dipstick cutoff of trace or 1+. The EQ-5D index was used for the health outcome. Prevalence estimates of ACR ≥30 mg/g and >300 mg/g vs dipstick ≥trace and ≥1+ in adults aged ≥20 years were 7.2% and 0.9% vs 9.1% and 1.2%, respectively. For ACR ≥30 mg/g detection, the sensitivity, specificity, and positive/negative predictive values of dipstick ≥trace were 43.6%, 93.6%, 34.6%, and 95.5%, respectively. When risk categories created based on dipstick cutoffs were compared with those based on ACR cutoffs, 10.4% of the total population was reclassified to different risk categories, with only 3.9% reclassified to the same CKD category. Akaike information criterion values were lower, and non-fatal disease burdens of CKD were larger, in models predicting EQ-5D index using ACR-based categories compared to those using dipstick-based categories, even after adjusting for confounders. In conclusion, the urine dipstick test had poor sensitivity and high false-discovery rates for ACR ≥30 mg/g detection, and classified a large number of individuals into different CKD risk categories compared with ACR-based categories. Therefore, ACR assessments in CKD screening appear beneficial for a more accurate prediction of worse quality of life.
Park et al. (Thu,) conducted a cross-sectional in Chronic kidney disease (n=20,759). Urine albumin:creatinine ratio (ACR) vs. Urine dipstick test was evaluated on Prevalence of albuminuria (ACR ≥30 mg/g vs dipstick ≥trace). The urine dipstick test had poor sensitivity (43.6%) and a high false-discovery rate for detecting albuminuria (ACR ≥30 mg/g) compared to the albumin:creatinine ratio.