Diagnostic accuracy of urine dipstick testing for albumin-to-creatinine ratio and albuminuria: A systematic review and meta-analysis

Abstract

Background: The accuracy of urine dipsticks to detect increased albuminuria is uncertain. We aimed to assess the diagnostic accuracy of urine dipsticks for detecting albuminuria. Methods: A systematic review of studies that assessed the diagnostic accuracy of urine dipstick testing for detecting albuminuria has been conducted (using as reference standard the albuminuria in a 24-hour sample or the albumin-to-creatinine ratio) in Scopus, PubMed, and Google Scholar. The risk of bias of the included studies has been assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Whenever possible, we performed meta-analyses for sensitivity and specificity. The certainty of the evidence has also been assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: A total of 14 studies have been included in this review, having assessed all albumin-to-creatinine ratio (ACR) as assessed standard. Each study used different dipstick types. The resulting pooled sensitivity and specificity for each cutoff point were as follows: for ACR >30 mg/g (13 studies): 0.82 (95% confidence interval: 0.76-0.87) and 0.88 (0.83-0.91); for ACR 30-300 mg/g (7 studies): 0.72 (0.68-0.77) and 0.82 (0.76-0.89); and for ACR >300 mg/g (7 studies): 0.84 (0.71-0.90) and 0.97 (0.95-0.99), respectively. An overall high risk of bias, an important heterogeneity in all pooled analysis, and a very low certainty of the evidence have been found. Conclusions: Pooled sensitivity and specificity of urine dipsticks have been calculated for different ACR cutoff points. However, the dipstick types differed across studies, and the certainty of the evidence was very low. Thus, further well-designed studies are needed to reach more confident estimates and to assess accuracy differences across dipstick types. Registration: PROSPERO (CRD42019124637).

Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes

“…However, it can be erroneously affected by changes in creatinine generation because of extremes of diet or muscle mass, 31,32 and it naturally fluctuates without intervention or disease progression 33 . Albuminuria can also be detected using a dipstick, but the associated low sensitivity renders this testing method useful only for screening that should be repeated when negative 34‐36 . For these reasons, an early morning measurement of UACR is preferred, and diagnosis of CKD requires persistence of albuminuria over at least 3 months 37 …”

Acidic urine is associated with poor prognosis in patients with bladder cancer undergoing radical cystectomy

“…A systemic review and meta-analysis defined clinically significant albuminuria as a dipstick test value of 2+ (albuminuria>30 ml/dl) (20). Accordingly, we used the same cutoff value for the clinical albuminuria classification.…”

ATR‐FTIR Spectroscopy for Early Detection of Diabetic Kidney Disease

“…: 76-89 %), respectively, for microalbuminuria detection. [16] Conversely, the gold standard measure of albumin excretion is the urinary albumin creatinine ratio (UACR). [10] This test quantifies albumin content using an enzyme linked immunosorbent assay (ELISA), whereby changes in sample absorbance upon exposure to albumin antibodies is related to the albumin content of the urine; this is then corrected for urinary creatinine [17] This test can detect albumin concentrations in urine down to 2 mg/L, however it is expensive, time consuming, and can only be performed in a pathology laboratory, limiting its point of care use, particularly in rural and remote settings.…”

“…: 68–77 %) and 82 % (95 % C.I. : 76–89 %), respectively, for microalbuminuria detection [16] . Conversely, the gold standard measure of albumin excretion is the urinary albumin creatinine ratio (UACR) [10] .…”