Abstract
Abstract Background: Chronic kidney disease (CKD) needs to be detected early in order to prevent a poor outcome in the general population. A semiquantitative evaluation based on a dipstick has become available to detect the urinary albumin-to-creatinine ratio (ACR) and proteinuria simultaneously in spot urine samples. The aim of this study was to compare dipstick ACR with proteinuria for CKD screening in a primary healthcare setting. Methods: This cross-sectional study analyzed 88,479 subjects who underwent a health check up at 16 health promotion centers in 13 Korean cities. Dipstick ACR and proteinuria was measured using the automated urine test strip analyzer UC-3500 (Sysmex, Kobe, Japan). CKD definition and risk categories according to the 2012 Kidney Disease: Improving Global Outcomes guidelines were created using a combination of eGFR and albuminuria. Albuminuria was defined using dipstick ACR ≥ 30 mg/g and dipstick proteinuria as ≥ trace or protein-to-creatinine ratio (PCR) ≥ 150 mg/g. Results: The prevalence of CKD using dipstick ACR, proteinuria, and PCR were 16.3%, 12.7%, and 11.9%, respectively. The concordance rates between the dipstick ACR- and proteinuria- or PCR-based CKD risk categories were 88.76% (κ = 0.567) and 92.06% (κ = 0.683), respectively. On being grouped according to dipstick proteinuria, CKD risk categories would be underestimated than be overestimated. 37.2% and 37.6% of the subjects with ≥ moderately increased CKD risk using ACR-based category were reclassified into lower risk CKD using dipstick proteinuria (≥ trace) and PCR, respectively. Conclusion: The CKD risk category using dipstick proteinuria was underestimated compared to the ACR-based CKD risk category. These data suggest that screening of CKD using dipstick ACR is recommended in primary healthcare settings.
Highlights
Chronic kidney disease (CKD) is being increasingly recognized as a major global health problem [1]
CKD is considered a significant risk factor for end-stage kidney disease and cardiovascular disease and premature death [2,3]. It needs to be detected early in order to prevent a poor outcome, but it is usually asymptomatic in its early stages. It can be initially suspected based on routine laboratory tests such as the estimated glomerular filtration rate or the presence of kidney damage markers such as proteinuria or albuminuria
The 2012 KDIGO guidelines recommend that CKD can be classified based on cause, the GFR category, and the albuminuria category
Summary
Chronic kidney disease (CKD) is being increasingly recognized as a major global health problem [1]. CKD is considered a significant risk factor for end-stage kidney disease and cardiovascular disease and premature death [2,3]. It needs to be detected early in order to prevent a poor outcome, but it is usually asymptomatic in its early stages. It can be initially suspected based on routine laboratory tests such as the estimated glomerular filtration rate (eGFR) or the presence of kidney damage markers such as proteinuria or albuminuria. The aim of this study was to compare dipstick ACR with proteinuria for CKD screening in a primary healthcare setting
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