Spot Urine Albumin-creatinine Ratio Research Articles

Mineralocorticoid receptor antagonists and reno-protection: What's the evidence & where do they fit? A guide for non-specialists.

The role of aldosterone has yet to be well appreciated in chronic kidney disease (CKD). Two variables define CKD: an estimated glomerular filtration rate of <60 ml/min/1.73 m2 and a spot urine albumin-creatinine ratio of >30 mg/g. Both are needed for an accurate diagnosis. The presence of CKD at this level is associated with an elevated risk of cardiovascular death and a greater risk of CKD progression to kidney failure and subsequent dialysis. This paper presents an overview of aldosterone's importance in CKD and its contribution to the inflammatory processes involved in CKD development. Data on outcomes, both surrogate and hard, related to outcomes on CKD progression will also be discussed in the context of mineralocorticoid blockade. Based on recent epidemiological data as well as data examining markers of diabetic kidney disease progression, it is clear that use of both renin-angiotensin system inhibitors and aldosterone receptor antagonists have a significant role in altering the natural history of kidney disease progression itself, as well as reducing the risk of cardiovascular events that generally accompany long-standing kidney disease. This paper will discuss these issues and the management of consequent hyperkalaemia when both steroidal and non-steroidal mineralocorticoid receptor antagonists are used in detail.

Urine Albumin-Creatinine Ratio Variability in People With Type 2 Diabetes: Clinical and Research Implications

Evidence has demonstrated that albuminuria is a key diagnostic and prognostic marker of diabetic chronic kidney disease, but the impact of its day-to-day variability has not been adequately considered. This study quantified within-individual variability of albuminuria in people with type 2 diabetes to inform clinical albuminuria monitoring. Descriptive cross-sectional analysis. People with type 2 diabetes (n=826, 67.1 [IQR, 60.3-72.4] years, 64.9% male) participating in the Progression of Diabetic Complications (PREDICT) cohort study. Four spot urine collections for measurement of urinary albumin-creatinine ratio (UACR) within 4 weeks. Variability of UACR. We characterized within-individual variability (coefficient of variation [CV], 95% limits of random variation, intraclass correlation coefficient), developed a calculator displaying probabilities that any observed difference between a pair of UACR values truly exceeded a 30% difference, and estimated the ranges of diagnostic uncertainty to inform a need for additional UACR collections to exclude or confirm albuminuria. Multiple linear regression examined factors influencing UACR variability. We observed high within-individual variability (CV 48.8%; 95% limits of random variation showed a repeated UACR to be as high/low as 3.78/0.26 times the first). If a single-collection UACR increased from 2 to 5mg/mmol, the probability that UACR actually increased by at least 30% was only 50%, rising to 97% when 2 collections were obtained at each time point. The ranges of diagnostic uncertainty were 2.0-4.0mg/mmol after an initial UACR test, narrowing to 2.4-3.2 and 2.7-2.9mg/mmol for the mean of 2 and 3 collections, respectively. Some factors correlated with higher (female sex; moderately increased albuminuria) or lower (reduced estimated glomerular filtration rate and sodium-glucose cotransporter 2 inhibitor/angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment) within-individual UACR variability. Reliance on the mean of 4 UACR collections as the reference standard for albuminuria. UACR demonstrates a high degree of within-individual variability among individuals with type 2 diabetes. Multiple urine collections for UACR may improve capacity to monitor changes over time in clinical and research settings but may not be necessary for the diagnosis of albuminuria. Albuminuria (albumin in urine) is a diagnostic and prognostic marker of diabetic chronic kidney disease. However, albuminuria can vary within an individual from day to day. We compared 4 random spot urinary albumin-creatinine ratio (UACR) samples from 826 participants. We found that a second UACR collection may be as small as a fourth or as large as almost 4 times the first sample's UACR level. This high degree of variability presents a challenge to our ability to interpret changes in albuminuria. Multiple collections have been suggested as a solution. We have constructed tools that may aid clinicians in deciding how many urine collections are required to monitor and diagnose albuminuria. Multiple urine collections may be required for individual monitoring but not necessarily for diagnosis.

Predictive Capacity of Plasma and Urinary Biomarkers for Persistent Albuminuria in Patients with Sickle Cell Disease

Introduction: Chronic kidney disease (CKD) is common in sickle cell disease (SCD) and is associated with increased mortality and morbidity. As albuminuria and changes in estimated glomerular filtration rate (eGFR) occur well after substantial structural and functional tissue damage have occurred, novel biomarkers are needed to predict CKD prior to its development. In this multicenter study, we investigated the association of multiple plasma and urine biomarkers with persistent albuminuria (PA) and their potential in predicting PA in patients with SCD. Methods: Adult subjects with HbSS or HbSb 0 thalassemia were enrolled in a prospective, longitudinal cohort study of CKD in SCD. We excluded patients with diabetic nephropathy, cancer, connective tissue disease, other glomerular diseases, end-stage kidney disease on dialysis, known infection with hepatitis (B or C) or HIV, and who had undergone bone marrow transplantation and solid organ transplantation. Participants were enrolled during routine clinical visits in the non-crisis, “steady states.” PA was defined as at least 2 of 3 spot urine albumin-creatinine ratio (ACR) values ≥30 mg/g or a single value ≥100 mg/g. At baseline evaluation, plasma was analyzed for biomarkers of coagulation activation (D-dimer, thrombin antithrombin complex [TAT], ratio of cleaved high molecular weight kininogen-to-intact high molecular weight kininogen [cHK/iHK]), endothelial dysfunction (endothelin-1 [ET1], vascular endothelial growth factor [VEGF], vascular cell adhesion molecule-1 [VCAM-1]), and urine was analyzed for kidney injury molecule 1 (KIM-1), nephrin and angiotensinogen (AGT) using commercially available ELISA. All urinary biomarkers were normalized to urine creatinine. For baseline values, a standard t-test was performed for continuous variables and a chi-square test was performed for categorical variables. Logistic regression analysis was performed to assess univariate predictors of research biomarkers for PA. Results: Of 278 evaluated subjects, 104 (37.4 %) had PA with a median ACR of 194.5 mg/g [IQR: 102.4, 487.1], and 174 subjects (62.6 %) did not have PA (non-PA) with a median ACR of 13.0 mg/g [IQR: 7.4, 22.4]. Subjects with PA were older, had lower hemoglobin and fetal hemoglobin, but higher systolic and diastolic blood pressures than those without PA (Table 1). Plasma VCAM-1, urinary KIM-1, and urinary AGT were significantly associated with PA with odds ratios of 1.001 (AUC: 0.636; 95% CI: 1.00, 1.002), 1.737 (AUC: 0.661; 95% CI: 1.226, 2.575), and 1.053 (AUC: 0.71; 95% CI: 1.029, 1.084), respectively (Table 2). Surprisingly, ET1 and urinary nephrin-creatinine ratio were not significantly associated with PA in this cohort. Conclusion: Urinary AGT exhibited the highest sensitivity for PA, while urinary KIM-1 was the most specific. The relatively modest sensitivity of KIM-1, a marker of renal tubular dysfunction, is likely because albuminuria in SCD results from both glomerular and tubular dysfunction. These results highlight the potential importance of urinary AGT as a key biomarker in identifying individuals at risk for PA. Our ongoing studies will evaluate the predictive capacity of these biomarkers for development of PA in SCD.

Mid-Trimester Spot Urinary Albumin/Creatinine Ratio as a Screening Tool in Prediction of Pre-eclampsia.

To determine utilization of spot urinary albumin/creatinine ratio (UACR) to predict subsequent development of preeclampsia, measured between 17 and 24weeks of gestational age in asymptomatic antenatal woman and determine their maternal and neonatal outcomes. In preeclampsia the basic pathology is generalized endothelial dysfunction. It causes glomerular endotheliosis which leads to proteinuria, decreased glomerular filtration rate and renal blood flow. Thus microalbuminuria is an early marker which can measured to predict preeclampsia. It is a prospective observational study, carried out for one year in a cohort of asymptomatic antenatal women at 17-24weeks of gestational age, attending hospital for routine antenatal check-up with a singleton pregnancy and no associated complications. Urine albumin and creatinine ratio (UACR) is measured at first visit, and women were followed till delivery and the maternal and foetal outcomes were recorded. Out of 81 pregnant women enrolled in the study, 58% belonged to 18-25years, 54.3% belonged to lower middle class. There was a significant difference in mean UACR among women who developed preeclampsia (PE) and gestational diabetes mellitus (GDM) with p value < 0.05. In the study there was significant association between severe PE, PE and GDM with UACR at 22 as cut-off, with p value < 0.05. In the study among those with UACR > 22, 2.5% had IUFD, 12.5% had LBW, and 7.5% were admitted to NICU. With the measurement of spot UACR in mid-trimester we can predict the development of preeclampsia before the onset of clinical manifestations. UACR > = 171mg/g predicted preeclampsia well before the onset of clinical manifestations with high sensitivity of 83.3% and specificity of 98.6%. The online version contains supplementary material available at 10.1007/s13224-023-01862-9.

Burden and predictors of diabetic kidney disease in an adult Ugandan population with new-onset diabetes

BackgroundDespite the growing evidence of diabetic kidney disease (DKD) in adult patients with long-standing diabetes in sub-Saharan Africa, data on its burden and correlates in adult African patients with new-onset diabetes are limited. We, therefore, undertook this study to determine the burden and predictors of DKD in an adult population with new-onset diabetes in Uganda.MethodsWe collected data on the relevant sociodemographic, clinical, anthropometric, and metabolic characteristics in 519 participants with newly diagnosed diabetes recruited from seven tertiary hospitals. A spot mid-stream urine sample was collected for determination of the urine albumin creatinine ratio (UACR) using Clinitek® microalbumin strips and a point-of-care Clinitek® status analyser. The estimated glomerular filtration rate (e-GFR) was determined using the Chronic Kidney Disease Epidemiology formula. The presence of DKD was defined as a spot UACR ≥ 3 mg/mmol with or without an e-GFR < 60 ml/min/1.73m2.ResultsThe median (IQR) age, UACR, and e-GFR of the participants were 48 years (39–57), 2.27 mg/mmol (1.14–3.41), and 121.8 ml/min/1.73m2 (105.4-133.9). UACR ≥ 3 mg/mmol and e-GFR < 60 ml/min/1.73m2 was noted in 175 (33.7%) and 7 (1.4%) participants, respectively. DKD was documented in 175 participants (33.7%). Compared with those without DKD, participants with DKD were more likely to be ≥ 50 years of age (53.7% vs. 43%, p = 0.02) and to have co-existing hypertension at the time of diagnosis (40.6% vs. 30.1%, p = 0.02). On multivariate analysis, self-reported hypertension comorbidity (OR 1.76 95% CI 1.24–2.48, p = 0.002) and body mass index (BMI) ≥ 30 kg/m2 (OR 0.61 95% CI 0.41–0.91, p = 0.02) were noted to independently predict DKD.ConclusionIn this study population, DKD was relatively common and was independently associated with self-reported hypertension comorbidity and BMI ≥ 30 kg/m2.

#3068 POTASSIUM LEVELS AND EGFR DO NOT PREDICT SEVERE HYPERKALEMIA FOLLOWING SPIRONOLACTONE INTRODUCTION IN PATIENTS WITH CKD AT HIGH RISK OF HYPERKALEMIA

Abstract Background and Aims Mineralocorticoid receptor antagonists (MRA) reduce blood pressure, albuminuria and the rate of disease progression in patients with chronic kidney disease (CKD) and albuminuria. Despite these apparent benefits, only a very small fraction of patients with CKD are treated with an MRA. This may in part be due to the fear of hyperkalemia (HK), which in the most severe cases can cause life-threatening arrythmias. Indeed, international guidelines and previous studies have excluded patients believed to be at high risk of severe HK from treatment with MRA including patients with pre-existing high serum potassium. To examine if the risk of HK can in fact be predicted by baseline potassium levels or eGFR, we performed a clinical study testing the effect of introducing spironolactone on plasma potassium (P-K) levels in closely monitored, high-risk patients excluded from other studies. Secondly, we analyzed the effect of spironolactone on eGFR and albuminuria. Method We included patients with eGFR 25-60 ml/min/1.73 m2 on maximal tolerated RAAS-blockade (ACEi or ARB) and a history of at least two HK-episodes (P-K &amp;gt; 4.5mmol/l) within 24 months prior to inclusion. Following dietary counselling on avoidance of potassium-rich foods, spironolactone was initiated at 25 mg daily. If tolerated as defined by a decline in eGFR &amp;lt; 30%, a P-K ≤ 5.5mmol/l and the absence of severe hypotension, the dose was increased to 50 mg after two weeks. Total follow-up was four weeks measuring P-K, eGFR, blood pressure and spot urine albumin creatinine ratio. Results from maximal tolerated dose were compared to baseline using paired t-test. In a post-hoc analysis, patients were grouped based on the occurrence of severe HK (P-K &amp;gt; 5.5mmol/l) or not, and baseline characteristics and the change from baseline to maximal dose were compared using unpaired t-test. Linear regression model was used to test the association between baseline P-K vs. P-K at maximal dose of spironolactone and the change in P-K from baseline to maximal dose of spironolactone vs. baseline eGFR. Results Fifty-eight patients were included with a mean age of 65 years. Forty-seven were males and 23 had diabetes. Forty-eight patients reached a spironolactone dose of 50 mg. Following spironolactone introduction, mean eGFR declined from 39 at baseline to 34ml/min/1.73 m2 (p&amp;lt;0.001) and albuminuria was reduced from a median of 1276mg/g to 654 mg/g (49%; 95%CI: 44 – 54%) with no significant change in blood pressure. Mean P-K increased 0.5mmol/l (95% CI 0.3 - 0.7mmol/l) from 4.7mmol/l to 5.2mmol/l. Seventeen patients developed severe HK with a P-K &amp;gt; 5.5mmol/l and four were briefly admitted with a P-K &amp;gt; 6.2mmol/l. Importantly, there was no difference in baseline P-K nor eGFR in patients that developed severe HK when compared with those that did not (4.70 vs 4.67 mmol/L, p = 0.83 and 36.2 vs. 40.1 ml/min/1.73 m2, p = 0,13). Furthermore, baseline P-K did not correlate with P-K at maximum spironolactone dose (Figure 1) and the change in P-K did not significantly correlate with baseline eGFR (Figure 2). Conclusion Short-term treatment with spironolactone in patients with CKD at high risk of HK leads to similar reductions in albuminuria and eGFR when compared with low-risk cohorts. With dietary counseling, 30% of patients will develop severe HK within 4 weeks. Importantly and contrary to common belief, neither baseline P-K levels nor baseline eGFR were associated with the development of severe HK. Thus, excluding patients from MRA treatment based solely on eGFR and P-K levels is not appropriate. Instead, we believe an empirical approach based on dietary counseling and close monitoring of P-K should be used.

#4666 ASSOCIATION BETWEEN URINARY ALBUMIN CREATININE RATIO AND CARDIOVASCULAR DISEASE

Abstract Background and Aims The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear. Method We obtained data from the 2011–2014 and 2019–2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score. Results Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men. Conclusion The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.

Accuracy of Spot Urine Albumin Creatinine Ratio With Respect to 24-Hour Urine Albumin for the Detection of Proteinuria in Antenatal Women With Preeclampsia: A Descriptive Study.

Background Among the hypertensive disorders of pregnancy, certain diseases like preeclampsia (PE) and eclampsia have the maximum impact on morbidity and mortality of the mother as well as the newborn. Proteinuria determination is used to assess renal damage in PE. There are several ways to evaluate proteinuria in pregnant women, but the gold standard remains the 24-hour urine albumin (24-h UA) excretion. Spot urine albumin creatinine ratio (UACR) can be used for rapid diagnosis of PE which is fast, reliable, and easy to use. Hence, our tertiary care center conducted the current study to assess the accuracy of spot UACR with 24-h UA for detecting proteinuria in antenatal women to diagnose PE and to evaluate the obstetric outcome in antenatal women with PE. Methodology A descriptive, cross-sectional study was conducted on 98 antenatal women diagnosed with PE.Urine albumin was done by dipstick method and the presence or absence of proteinuria was noted. Both, the 24-hurine sample and a random sample for spot UACR were sent for analysis. Results Spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria. Additionally, significant proteinuria was associated with an increased rate of induced labor, a cesarean section in patients, lower mean gestational age at the time of delivery, lower birth weight, and increased rate of intrauterine fetal death. Conclusion The study concluded that spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria and therefore, can be used for the diagnosis of proteinuria in women with PE. Hence, spot UACR is a reliable, faster, and more accurate method for the detection of proteinuria in PE and can be used for early diagnosis and timely management leading to a decrease in mortality and morbidity of the mother and the fetus.

Association between urinary albumin creatinine ratio and cardiovascular disease.

The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear. We obtained data from the 2011-2014 and 2019-2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score. Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men. The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.

Correlation of Mid-Trimester Spot Urinary Albumin: Creatinine Ratio With the Adverse Pregnancy Outcome.

Background Urinary albumin creatinine ratio (ACR) is a known method of measurement of microalbuminuria. Microalbuminuria may be an early marker of endothelial dysfunction which can lead to various complications during the course of pregnancy. The objective of our study was to evaluate the correlation of mid-trimester spot urinary ACR with the pregnancy outcome. Material and methods We performed a prospective cohort study in the department of Obstetrics & Gynaecology,All India Institute of Medical Sciences, Bhopal, for a period of one year. We studied 130 antenatal women between 14 and 28 weeks of gestation after obtaining written informed consent. The patients with ongoing urinary tract infection (UTI), pre-existing hypertension, or diabetes were excluded. Urinary samples were examined for spot ACR, and the women were followed untildelivery. Primary maternal outcomes were development of gestational hypertension, pre-eclampsia, gestational diabetes mellitus (GDM), and preterm labour. Neonatal outcome was assessed in terms of birth weight, the APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, and neonatal intensive care unit (NICU) admission. Results In our study, mean urinary ACR was 19.07±12.94 mcg/mg and median urinary ACR (IQR) was 18 (9.43-25.25) mcg/mg. Prevalence of microalbuminuria in our study was 19.2%. It was observed that urinary ACR level was significantly higher in women with maternal complications like GDM, gestational hypertension, preeclampsia, and preterm labour. Also, mean urinary ACR of women who developed preeclampsia was higher (37.53±31.85)compared to women who developed gestational hypertension (27.40±9.71). Urinary ACR level was significantly higher in babies with low APGAR scores and in babies who needed NICU admission (p value < 0.05). The sensitivity and specificity of spot urinary ACR to predict GDM and preeclampsia were found to be good as calculated from the receiver operating curve. Conclusion We found definite correlation of higher values of mid-trimester urinary ACR with the adverse pregnancy outcome.

Comparative estimation of proteinuria using spot urine albumin creatinine ratio and 24 hour urine protein among diabetics for detecting nephropathy

Purpose: Although proteinuria has been established as an independent risk factor of diabetic nephropathy, the timely and accurate estimation of proteinuria has scope for improvement. Hence, this study intends to compare the accuracy of spot sampled urine albumin creatinine ratio (UACR) to 24 hour urine protein among diabetics in the quantification of proteinuria. Design/Methodology/Approach: This prospective study was conducted amongst 120 patients diagnosed with type 2 diabetes mellitus. Two types of urine samples namely spot samples and 24-hour samples were analysed across an array of clinical variables including urine biochemistry, kidney failure and glomerular filtration rate. UACR in spot samples was correlated with the 24-hour urine protein levels. The sensitivity, accuracy, specificity and predictive values of UACR for proteinuria were determined. A p

Frequency of Hyperuricemia in Type-2 Diabetes Mellites and its Relation with Diabetic Nephropathy

Objectives: To determine the frequency of Hyperuricemia in patients with type-2 Diabetes Mellitus and to compare frequency of Diabetic Nephropathy in Hypouricemic vs Normouricemic patients with type-2 Diabetes.&#x0D; Study Design: Cross-sectional analytical study.&#x0D; Duration and Place of Study: Medicine Department Combined Military Hospital Peshawar, from Dec 2018 to May 2019.&#x0D; Methodology: Patients from both genders with type 2 Diabetes having glycosylated hemoglobin (HbA1c) ≥6.5%, Fasting Blood glucose ≥ to 7.0 mmol/L or random blood glucose ≥11.1 mmol/L were recruited from out Patient department.Participants were tested for serum uric acid, fasting blood glucose, Glycosylated hemoglobin (HbA1c) and Spot Urine Albumin Creatinine Ratio after 8 hours fasting.&#x0D; Results: Out of 111 patients enrolled Hyperuricemia was present in 40 (36.04%) patients of which 21 (52.50%) were male and 19 (47.50%) were female. Diabetic Nephropathy was present in 43(38.74%). Out of 43 patients having diabetic nephropathy, 25 (58.14%) were having hyperuricemia. The study observed a linear relationship between serum uric acid and type-2 diabetes duration, fasting blood glucose levels, glycosylated hemoglobin (HbA1c) and urinary Albumin creatinine ratio.&#x0D; Conclusion: Hyperuricemia is positively linked with diabetic complications in majority of patients with type-2 diabetes. Serum uric acid levels can be used as an early diagnostic parameter and can prognosticate diabetic nephropathy.Keywords: Diabetes mellitus, Diabetic nephropathy, Hyperuricemia, Microalbuminuria

Spot Urinary Albumin–Creatinine Ratio in Prediction of Pre-eclampsia: A Prospective Study

Spot Urinary Albumin–Creatinine Ratio in Prediction of Pre-eclampsia: A Prospective Study

Cost-effectiveness of population-based screening for microalbuminuria in people with type 2 diabetes mellitus in India.

Patients with diabetes have a higher risk of developing chronic kidney disease (CKD). Early detection of CKD through microalbuminuria screening, followed by treatment, delays the progression of CKD. We evaluated the cost-effectiveness of population-based screening of microalbuminuria among normotensive type 2 diabetes mellitus patients aged >40years compared with no screening scenario using a decision tree combined with the Markov model. We considered two scenarios: Scenario I - dipstick microalbuminuria followed by spot-urine albumin-creatinine ratio (ACR) and serum creatinine in sequence; Scenario II - spot urine ACR plus serum creatinine. A mathematical cohort of the target population was simulated over a lifetime horizon with an annual cycle. Data for the model were obtained from secondary resources. The incremental cost-effectiveness ratios (ICERs) were estimated for screening scenarios compared to nonscreening scenario, along with sensitivity analyses. The discounted ICER per quality-adjusted life years gained for annual microalbuminuria screening in the normotensive diabetic population in India were ₹ 24,114 (US$ 308) and ₹ 13,790 (US$ 176) for scenarios I and II, respectively. Annual screening by scenarios I and II resulted in a reduction of 180 and 193 end-stage renal disease (ESRD) cases per 100,000 population, respectively, resulting in a cost saving of ₹ 12.3 and 13.3 Crore spent on ESRD management over 10years. Both scenarios were also cost-effective even at the screening frequencies of 5 and 10 yearly. Microalbuminuria screening was cost-effective at the threshold of one-time GDP per capita in India.

RISK FACTORS FOR DIABETIC NEPHROPATHY IN DIABETES MELLITUS TYPE 1.

The aim: To find the risk factors of microalbuminuria and estimated Glomerular Filtration Rate (eGFR) in patients with type 1 diabetes mellitus. Materials and methods: One hundred ten patients of type 1 diabetes mellitus in this cross-sectional study at diabetic and endocrinology center in Al-Najaf during the period from September 2021 to March 2022. All patients were asked about sociodemographic characteristics (age, gender, smoking, duration of DM type1, family history of DM type1), measured (body mass index BMI, blood pressure) and laboratory investigations done to all patients (G.U.E, s. creatinine, lipid profile, HBA1C, calculated estimated Glomerular Filtration Rate (eGFR) and Spot Urine Albumin-Creatinine Ratio (ACR). Results: Out of 110 patients, 62 male and 48 female, the mean age was (22±12). The patients with microalbuminuria (ACR ≥ 30 mg/g) show statistically significant with increase HBA1C, duration of DM type 1, total cholesterol (T.C), low density lipoprotein (LDL), triglycerides (TG) and family history of DM type 1, while there were not statistically significant with age, gender, smoking, BMI, eGFR, high density lipoprotein (HDL) and hypertension. Patients with eGFR<90mL/min/1.73m2 show statistically significant with increase HBA1C, duration of DM type1, LDL, TG, T.C, while significantly decrease in HDL and there were not statistically significant with age, gender, smoking, family history of DM type 1, BMI and hypertension. Conclusions: The degree of glycemic control, duration of type1 (DM) and dyslipidemia were associated with increased microalbuminuria and reduced eGFR (nephropathy). Family history of DM type1 was risk factor for microalbuminuria.

Prevalence and Risk Factors for Kidney Disease and Elevated BP in 2-Year-Old Children Born Extremely Premature.

Extremely low gestational age neonates born <28 weeks gestation are at risk for chronic disease. We sought to describe the prevalence of kidney outcomes by gestational age and determine risk factors for their development. The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study examined kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo NeuroProtection Trial (PENUT) study. Kidney function, urine albumin, and BP were measured at 2-year (24±2 months) corrected gestational age. We compared outcomes across gestational age categories and evaluated associations between kidney-related outcomes and neonatal and maternal characteristics. The primary outcome was eGFR <90 ml/min per 1.73 m2 (CKD); secondary outcomes were spot urine albumin-creatinine ratio ≥30 mg/g (albuminuria) and either systolic BP or diastolic BP >90th percentile for height, age, and sex. A total of 832 survived to 2 years, and 565 (68%) had at least one outcome measured. Overall, 297 (53%) had one abnormal kidney outcome; 61 (18%) had an eGFR <90 ml/min per 1.73 m2, 155 (36%) had albuminuria, 65 (22%) had elevated systolic BP, and 128 (44%) had elevated diastolic BP. Gestational age (odds ratio, 0.94; 95% confidence interval, 0.89 to 0.99), birth weight z-score (odds ratio, 0.92; 95% confidence interval, 0.85 to 0.98), and prenatal steroids (odds ratio, 1.23; 95% confidence interval, 1.08 to 1.39) were associated with an eGFR <90 ml/min per 1.73 m2. An elevated systolic BP was associated with indomethacin use (odds ratio, 1.18; 95% confidence interval, 1.04 to 1.33) and Black race (odds ratio, 1.19; 95% confidence interval, 1.01 to 1.39); elevated diastolic BP was associated with male sex (odds ratio, 1.29; 95% confidence interval, 1.12 to 1.49), severe AKI (odds ratio, 1.24; 95% confidence interval, 1.04 to 1.48), and indomethacin use (odds ratio, 1.16; 95% confidence interval, 1.01 to 1.33). Approximately 18% of extremely low gestational age neonates have CKD, 36% have albuminuria, 22% have an elevated systolic BP, and 44% have an elevated diastolic BP at 2 years of age. Gestational age, birthweight z-score, and prenatal steroids were associated with CKD. Male sex, Black race, indomethacin use, and severe AKI were associated with elevated BP. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_07_19_CJN15011121.mp3.

MO377: Correlation Between 24-H Proteinuria and Spot Urine Albumin-Creatinine Ratio in Biopsy-Proven Glomerular Diseases

Abstract BACKGROUND AND AIMS The gold standard for measurement of protein excretion is a 24-h urine collection. However, due to the cumbersome nature as well as the frequent errors in sample collection, it has been suggested that the measurement of albumin-creatinine ratio (ACR) in a spot urine sample could replace 24-h proteinuria as a valid method for the diagnosis and follow-up of renal disease, which is supported by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The aim of our study was to assess the correlation between 24-h proteinuria and spot urine ACR in patients with biopsy-proven glomerulonephritis, METHOD We identified patients with biopsy-proven glomerular diseases who were evaluated during their disease course at our center between 1 January 2005 and 31 December 2021, and included patients with paired 24 h and spot urine samples simultaneously collected at the same day. We excluded patients with interstitial or vascular causes for kidney disease. We contrasted correlation of ACR and 24 h proteinuria according to demographic data, glomerular filtration rate measured at the day of urine collection, and type of glomerular disease. RESULTS A total of 977 paired 24-hr proteinuria and spot urine ACR samples were collected at the same day from 370 patients and included in this study. The mean age of the selected population was 52.1 ± 17.7 years, with a median serum creatinine of 1.26 mg/dL (IQR: 0.94–1.74) and mean eGFR measured by CKD-EPI of 62.4 ± 30.1 mL/min. Median 24-h proteinuria was 1.48 g/day (IQR: 0.59–3.39), and the median ACR was 539 mg/g (IQR: 131–1569). We found an excellent correlation between ACR and 24-h proteinuria (Spearman's r = 0.86, P &amp;lt; 0.001). This correlation was reproducible across all CKD stages, and remained strong even in patients with eGFR &amp;lt;30 mL/min/1.73 m2 (Spearman's r = 0.85, P &amp;lt; 0.001). On the other hand, after stratifying the cohort according to grade of proteinuria, we found that correlation was significantly weaker when proteinuria &amp;gt;3 g/day (Spearman's r = 0.50, P &amp;lt; 0.001) compared with lower grade proteinuria &amp;lt;3 g/day (r = 0.79, P &amp;lt; 0.001). We found no differences in correlation between ACR and 24-h proteinuria according to the type of glomerular disease, with excellent correlation across all glomerulonephritides. ROC analysis showed that a ACR cutoff of &amp;gt;250 mg/g was the best predictor for 24-h proteinuria &amp;gt;1 g/day, with an area under the curve (AUC) of 0.933, sensitivity 91% and specificity 81%, while an ACR cutoff of &amp;gt;800 mg/g best predicted a 24-hour proteinuria of &amp;gt;3.5 g/day, with an AUC of 0.922, sensitivity of 92% and specificity of 76%. CONCLUSION There is an excellent correlation between ACR and 24-h proteinuria in patients with proteinuria &amp;lt;3 g/day independent from eGFR and without significant variation according to the type of glomerular disease. In patients with proteinuria &amp;gt;3 g/day, ACR correlates poorly with proteinuria. We suggest that patients with higher grade proteinuria should always be assessed with a 24-h urine sample protein excretion for therapeutic decisions and follow-up in glomerular diseases.

Carotid Atherosclerosis, Microalbuminuria, and Estimated 10-Year Atherosclerotic Cardiovascular Disease Risk in Sub-Saharan Africa

Carotid atherosclerosis and microalbuminuria are associated with atherosclerotic cardiovascular disease (ASCVD) but are understudied in sub-Saharan Africa. To evaluate the association of carotid atherosclerosis and microalbuminuria with 10-year ASCVD risk in middle-aged sub-Saharan African individuals. This cross-sectional study conducted analyses of baseline data from the African-Wits-INDEPTH (International Network for the Demographic Evaluation of Populations and Their Health in Low- and Middle-Income Countries) genomic study (AWI-Gen). Women and men aged 40 to 60 years without baseline CVD and drawn from Burkina Faso, Ghana, Kenya, and South Africa were included. Hypotheses for the analyses were formulated after data collection. The main exposures were carotid atherosclerosis, assessed using carotid intima-media thickness (CIMT) using B-mode ultrasonography, and microalbuminuria, measured using spot urine albumin (SUA) and urine albumin-creatinine ratio (uACR). The main outcome was high ASCVD risk, defined as a 2018 Pooled Cohort Equations score of 7.5% or greater. Associations were estimated using adjusted multivariable logistic regression analyses. A total of 9010 participants with a mean (SD) age of 50 (6) years and 4533 (50.3%) women were included. High CIMT, SUA, and uACR were each associated with older age (eg, mean [SD] age of participants with high vs reference range CIMT: 55 [5] years vs 50 [6] years; P < .001) and high prevalence of both diabetes and hypertension (eg, hypertension among those with high vs reference range SUA: 213 of 1117 [19.1%] vs 356 of 2549 [14.0%]; P < .001). Smokers were likely to have higher vs reference range SUA (210 [18.8%] vs 407 [16.0%]) and uACR (138 of 707 [19.5%] vs 456 of 2797 [16.3%]). Carotid atherosclerosis was common in Burkina Faso (82 of 262 [31.3%]) and Ghana (91 [34.7%]), while microalbuminuria, measured by SUA, was common in Kenya (272 [24.4%]) and South Africa (519 [46.5%]). SUA was associated with higher odds of carotid atherosclerosis (odds ratio [OR], 1.77; 95% CI, 1.04-3.01) compared with uACR (OR, 0.51; 95% CI, 0.27-0.95). Common CIMT, SUA, and uACR were associated with 10-year ASCVD risk, with CIMT having a stronger association with 10-year ASCVD risk in both women (OR, 1.95; 95% CI, 1.78-2.14) and men (OR, 1.73; 95% CI, 1.55-1.93) than SUA (women: OR, 1.29; 95% CI, 1.12-1.43; men: OR, 1.46; 95% CI, 1.26-1.55) and uACR (women: OR, 1.32; 95% CI, 1.10-1.54; men: OR, 1.35; 95% CI, 1.15-1.46). The presence of microalbuminuria measured by SUA may indicate risk of subclinical carotid atherosclerosis and high 10-year ASCVD risk in middle-aged residents of sub-Saharan Africa. These data should be confirmed in longitudinal studies of cardiovascular events.

Urinary Albumin Creatinine Ratio has no Significant Association with Retinopathy in Individuals with Type 1 Diabetes Mellitus

Background The relationship between diabetic retinopathy (DR) and nephropathy in type 1 diabetes mellitus (T1DM) is controversial. This study assessed the utility of the spot urinary albumin creatinine ratio (UACR) as a parameter for correlating diabetic nephropathy with DR in individuals with T1DM in Basrah. Methods The study was a cross-sectional observational study of 216 patients with T1DM (16–49 years old) with different DR types. We used demographic variables, different T1DM-related variables (onset and duration of T1DM, glycemic control, latency between T1DM and DR onset, age of onset of DR), and biochemical investigations, such as spot UACR, renal function tests, glycated hemoglobin (HbA1c), anti-glutamic acid decarboxylase-65 (anti-GAD-65) antibody, lipid profile, and thyrotropin. We used ordinal regression analysis to test for the possible primary covariates and adjusted the findings with an analysis of covariates (ANCOVA). Results The patient population showed a slight male preponderance, and uncontrolled T1DM with high HbA1c was found in 93% of the cohort. The mean UACR was 64.37 ± 8.99 mg/g. Normal UACR levels were seen in approximately 60% of the cohort (n=129). Sixty-five individuals were reported to have DR, with a median age of onset of 34 ± 8 years and a median latency period of 13 ± 7 years. UACR had no significant relationship with DR development at any association level, with or without adjustment for the composite regression factors. Conclusion There was no significant association between UACR at any level and DR development before and after adjustment for all of the possible covariates in this study.

Evaluation of spot urinary albumin-creatinine ratio as a screening tool in prediction of preeclampsia

Evaluation of spot urinary albumin-creatinine ratio as a screening tool in prediction of preeclampsia