Abstract
The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.
Highlights
There has been a rapid worldwide increase in the prevalence of type 1 and 2 diabetes mellitus [1], which has caused an increased incidence of diabetic kidney disease (DKD), an intermediate term that can refer to diabetic nephropathy (DN) and chronic kidney disease (CKD) in individuals with diabetes resulting from other causes, such as hypertension [2]
The urinary albumin-to-creatinine ratio (UACR) was originally introduced into clinical practice to detect incipient DN, as reflected by urinary albumin excretion (UAE), but it has since been shown to be a marker that can predict a variety of important health outcomes, including cardiovascular events, kidney failure, and mortality
It is unclear whether a UACR > 30 mg/g Cr is associated with an increased risk of incident diabetes mellitus and CKD-related mortality
Summary
The UACR was originally introduced into clinical practice to detect incipient DN, as reflected by urinary albumin excretion (UAE), but it has since been shown to be a marker that can predict a variety of important health outcomes, including cardiovascular events, kidney failure, and mortality. It is unclear whether a UACR > 30 mg/g Cr is associated with an increased risk of incident diabetes mellitus and CKD-related mortality. The prevalence of normoalbuminuria (NA; UACR < 30 mg/g Cr) in CKD increases with age, with overall means of 9.7% and 4.3% in persons with or without diabetes mellitus, respectively [5]
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