Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium

Abstract

Albuminuria is an under-recognized component of chronic kidney disease definition, staging, and prognosis. Guidelines, particularly for hypertension, conflict on recommendations for urine albumin-to-creatinine ratio (ACR) measurement. Separately among 1 344 594 adults with diabetes and 2 334 461 nondiabetic adults with hypertension from the chronic kidney disease Prognosis Consortium, we assessed ACR testing, estimated the prevalence and incidence of ACR ≥30 mg/g and developed risk models for ACR ≥30 mg/g. The ACR screening rate (cohort range) was 35.1% (12.3%–74.5%) in diabetes and 4.1% (1.3%–20.7%) in hypertension. Screening was largely unrelated to the predicted risk of prevalent albuminuria. The median prevalence of ACR ≥30 mg/g across cohorts was 32.1% in diabetes and 21.8% in hypertension. Higher systolic blood pressure was associated with a higher prevalence of albuminuria (odds ratio [95% CI] per 20 mm Hg in diabetes, 1.50 [1.42–1.60]; in hypertension, 1.36 [1.28–1.45]). The ratio of undetected (due to lack of screening) to detected ACR ≥30 mg/g was estimated at 1.8 in diabetes and 19.5 in hypertension. Among those with ACR <30 mg/g, the median 5-year incidence of ACR ≥30 mg/g across cohorts was 23.9% in diabetes and 21.7% in hypertension. Incident albuminuria was associated with initiation of renin-angiotensin-aldosterone system inhibitors (incidence-rate ratio [95% CI], diabetes 3.09 [2.71–3.53]; hypertension 2.87 [2.29–3.59]). In conclusion, despite similar risk of albuminuria to those with diabetes, ACR screening in patients with hypertension was low. Our findings suggest that regular albuminuria screening should be emphasized to enable early detection of chronic kidney disease and initiation of treatment with cardiovascular and renal benefits.

Adolescent Blood Pressure and the Risk for Early Kidney Damage in Young Adulthood

“…MHS insures and provides care to 26% of the Israeli population, but its representativeness among the Jewish population who is obliged for military service is ≈40%. The MHS chronic disease registry, part of the chronic kidney disease prognosis consortium, 14 was established in 2001 and collects data from electronic medical records, laboratory results, pharmacy prescriptions, and purchase logs. Laboratory data are analyzed in a central laboratory.…”

The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

“…These data are important to inform on the need of measuring albuminuria in high-risk populations and to better interpret results of ACR monitoring at the bedside. Still, low rates of albuminuria monitoring and detection are features of all health systems globally [22].…”

Identifying Distinct Risk Thresholds of Glycated Hemoglobin and Systolic Blood Pressure for Rapid Albuminuria Progression in Type 2 Diabetes From NHANES (1999–2018)

“…Although various risk factors could affect the development of albuminuria, abundant studies have confirmed that raised blood pressure and dysglycaemia are two critical risk factors for albuminuria ( 8 – 11 ). Cumulative evidence emphasizes that control of glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) are significant in decreased ACR for both T2DM and Diabetic kidney disease (DKD) patients ( 12 , 13 ).…”

“…In addition, the studies on the risk relationship between SBP and ACR have also been extensively reported. A meta-analysis included 31 cohorts in the world and demonstrated that each 20 mmHg increase in SBP was associated with a 1.5-fold higher prevalence of albuminuria (ACR ≥ 30 mg/g) in diabetes ( 11 ). It was also reported that only SBP ≤ 120 mmHg was associated with the lowest risk of new-onset microalbuminuria ( 16 ).…”