Skipped UACR Testing Often Leads to Missed Albuminuria in Patients with Diabetes, Hypertension

Josef Coresh, MD

A new study is underlining the importance of testing albuminuria levels in patients with diabetes or hypertension in the US.

Despite inclusion improving early detection of chronic kidney disease (CKD), the meta-analysis of patient data from the global CKD Prognosis Consortium suggests just 35% of patients with diabetes and 4% of patients with hypertension underwent UACR testing.

“We’re really missing a huge number of chronic kidney disease cases that should be detected and treated, and apart from all the other downsides of letting it go untreated, there is the fact that COVID-19 outcomes are often much worse for people with kidney disease,” said senior investigator Josef Coresh, MD, the George W. Comstock Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health, in a statement.

With conflicting guideline recommendations surrounding UACR measurements, Coresh and a team of colleagues from Johns Hopkins sought to evaluate trends in testing among adult patients with diabetes or patients with hypertension but without diabetes from within the CKD Prognosis Consortium, which has collected data from than 80 unique patient cohorts from 40 different countries since 2009. Using the CKD Prognosis Consortium, which has patient-level data from more than 11 million participants, investigators were able to identify 31 subcohorts including 1,344,594 adults with diabetes and 25 subcohorts including 2,334,461 nondiabetic patients with hypertension for inclusion in their analysis.

For the purpose of analysis, investigators planned to examine rates of UACR testing. Additionally, Investigators designed their analysis with the intent of estimating the prevalence and incidence of UACR of 30 mg/g or less as well as development of risk models for those with UACR of 30 mg/g or greater.

Initial analysis indicated screening rates of 35.1% (12.3-74.5%) of patients with diabetes and 4.1% (1.3-20.7%) of patients with hypertension. Investigators found incidence of UAACR testing was unrelated to the predicted risk of prevalent albuminuria. Results also suggested the median prevalence of UACR of 30 mg/g or greater was 32.1% across the diabetes cohorts and 21.8% across the hypertensive cohorts.

When assessing factors associated with increased prevalence of albuminuria, higher systolic blood pressure was associated with a 50% increase in odds per 20 mmHg in patients with diabetes (HR, 1.50; 95% CI, 1.42-1.60) and a 36% increase in odds per 20 mmHg in patients with hypertension (HR, 1.36; 95% CI, 1.28-1.45). Investigators highlighted the estimated ratio of undetected to detected UACR of 30 mg/g or greater was 1.8-to-1 in patients with diabetes and 19.5-to-1 in patients with hypertension.

Among those with a UACR below 30 mg/g, the median 5-year incidence of UACR reaching or exceeding 30 mg/g was 23.9% in patients with diabetes and 21.7% in patients with hypertension. Additional analysis revealed incident albuminuria was associated with increased initiation of RAAS inhibitors, with incidence-rate ratios of 3.09 (95% CI, 2.71-3.53) in patients with diabetes and 2.87 (95% CI 2.29-3.59) in patients with hypertension.

“Our findings suggest that albuminuria screening should be used much more often for detecting chronic kidney disease early, so that patients can benefit from earlier treatment,” said Jung-Im Shin, MD, an assistant professor in the Department of Epidemiology at the Bloomberg School, in a statement.

This study, “Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium,” was published in Hypertension.