Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant-Based Meta-analysis.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
15 09 2020
15 09 2020
Historique:
pubmed:
14
7
2020
medline:
22
12
2020
entrez:
14
7
2020
Statut:
ppublish
Résumé
Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead. To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging. Individual participant-based meta-analysis. 12 research and 21 clinical cohorts. 919 383 adults with same-day measures of ACR and PCR or dipstick protein. Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g). Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR. Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample. Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis. National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
Sections du résumé
BACKGROUND
Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.
OBJECTIVE
To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.
DESIGN
Individual participant-based meta-analysis.
SETTING
12 research and 21 clinical cohorts.
PARTICIPANTS
919 383 adults with same-day measures of ACR and PCR or dipstick protein.
MEASUREMENTS
Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).
RESULTS
Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.
LIMITATION
Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.
CONCLUSION
Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.
PRIMARY FUNDING SOURCE
National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.
Identifiants
pubmed: 32658569
doi: 10.7326/M20-0529
pmc: PMC7780415
mid: NIHMS1645865
doi:
Substances chimiques
Reagent Strips
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
426-435Subventions
Organisme : NIDDK NIH HHS
ID : U24 DK060990
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060963
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK079626
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK061022
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK100446
Pays : United States
Investigateurs
Kevan R. Polkinghorne
(KR)
Steven J. Chadban
(SJ)
Robert Atkins
(R)
Adeera Levin
(A)
Ognjenka Djurdjev
(O)
Mila Tang
(M)
Hernan Rincon Choles
(H)
Edward Horwitz
(E)
Farsad Afshinnia
(F)
Raymond R. Townsend
(RR)
Katherine R. Tuttle
(KR)
Kenn B. Daratha
(KB)
Radica Alicic
(R)
Cami R. Jones
(CR)
Alex R. Chang
Gurmukteshwar Singh
(G)
Jamie Green
(J)
H. Lester Kirchner
(HL)
Simon Sawhney
(S)
Corri Black
(C)
Angharad Marks
(A)
Lynn Robertson
(L)
Amit X. Garg
(AX)
Hiddo J.L. Heerspink
(HJ)
Brian J. Lee
(BJ)
Nigel Brunskill
(N)
Rupert W. Major
(RW)
David Shepherd
(D)
James Medcalf
(J)
Jack Wetzels
(J)
Peter Blankestijn
(P)
Arjan van Zuilen
(A)
Jan van de Brand
(J)
Massimo Cirillo
(M)
Licia Iacoviello
(L)
Girish N. Nadkarni
(GN)
Erwin P. Bottinger
Ruth J.F. Loos
(RJ)
Stephen B. Ellis
(SB)
José M. Valdivielso
(JM)
Marcelino Bermúdez-López
(M)
Milica Bozic
(M)
Serafí Cambray
(S)
Benedicte Stengel
(B)
Marie Metzger
(M)
Martin Flamant
(M)
Pascal Houillier
(P)
Jean-Philippe Haymann
(JP)
Katsuyuki Miura
(K)
Akira Okayama
(A)
Aya Kadota
(A)
Sachiko Tanaka
(S)
Nikita Stempniewicz
(N)
John Cuddeback
(J)
Elizabeth Ciemins
(E)
Emily Carbonara
(E)
Stephan Dunning
(S)
Robert G. Nelson
(RG)
William C. Knowler
(WC)
Helen C. Looker
(HC)
Csaba P. Kovesdy
(CP)
Keiichi Sumida
(K)
Miklos Molnar
(M)
Praveen Potukuchi
(P)
Michelle Pena
(M)
Dick de Zeeuw
(D)
David M.J. Naimark
(DM)
Navdeep Tangri
(N)
Takamasa Kayama
(T)
Tsuneo Konta
(T)
Patrick B. Mark
(PB)
Jamie P. Traynor
(JP)
Peter C. Thomson
(PC)
Colin C. Geddes
(CC)
Josef Coresh
(J)
Shoshana H. Ballew
(SH)
Ron T. Gansevoort
(RT)
Morgan E. Grams
(ME)
Orlando Gutierrez
(O)
Anna Köttgen
(A)
Andrew S. Levey
(AS)
Kunihiro Matsushita
(K)
Elke Schäffner
(E)
Mark Woodward
(M)
Luxia Zhang
(L)
Jingsha Chen
(J)
Yingying Sang
(Y)
Aditya Surapeneni
(A)
Commentaires et corrections
Type : CommentIn
Références
J Hypertens. 2006 Mar;24(3):541-8
pubmed: 16467658
Am J Kidney Dis. 2013 Dec;62(6):1102-8
pubmed: 24041612
Am J Kidney Dis. 2012 Nov;60(5):787-94
pubmed: 22721931
J Am Soc Nephrol. 2010 Aug;21(8):1355-60
pubmed: 20634296
Lancet Diabetes Endocrinol. 2015 Jul;3(7):514-25
pubmed: 26028594
Ann Clin Biochem. 2009 May;46(Pt 3):205-17
pubmed: 19389884
Clin Chem. 2000 Mar;46(3):392-8
pubmed: 10702527
Arch Intern Med. 2005 Apr 25;165(8):947-53
pubmed: 15851648
JAMA. 2010 Feb 3;303(5):423-9
pubmed: 20124537
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Lancet. 2010 Jun 12;375(9731):2073-81
pubmed: 20483451
Clin Chem. 2007 Apr;53(4):766-72
pubmed: 17332152
Ann Clin Biochem. 2009 Nov;46(Pt 6):468-76
pubmed: 19729498
Kidney Int. 2018 Jun;93(6):1442-1451
pubmed: 29605094
JAMA. 2019 Nov 8;:
pubmed: 31703124
JAMA. 2011 Apr 20;305(15):1553-9
pubmed: 21482743
J Am Soc Nephrol. 2020 Mar;31(3):591-601
pubmed: 32024663
Kidney Int. 2011 Jun;79(12):1341-52
pubmed: 21307840
PLoS One. 2017 Feb 2;12(2):e0171106
pubmed: 28151999
Am J Kidney Dis. 2011 Jul;58(1):19-28
pubmed: 21411199
J Clin Lab Anal. 2012 Feb;26(2):82-92
pubmed: 22467323
Int J Epidemiol. 2013 Dec;42(6):1660-8
pubmed: 23243116
J Clin Epidemiol. 2005 Oct;58(10):982-90
pubmed: 16168343
EJIFCC. 2017 Dec 19;28(4):258-267
pubmed: 29333145
Nephrology (Carlton). 2011 Sep;16(7):633-41
pubmed: 21771177
JAMA. 2016 Jan 12;315(2):164-74
pubmed: 26757465
Clin Exp Nephrol. 2009 Dec;13(6):537-66
pubmed: 19960305
Kidney Int. 2011 Jun;79(12):1331-40
pubmed: 21289598
N Engl J Med. 2016 Feb 4;374(5):411-21
pubmed: 26544982
Med J Aust. 2012 Aug 20;197(4):224-5
pubmed: 22900872
Clin Exp Nephrol. 2007 Mar;11(1):51-5
pubmed: 17384998
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Kidney Res Clin Pract. 2014 Dec;33(4):199-203
pubmed: 26885477
Nefrologia. 2011;31(3):331-45
pubmed: 21780317
Nephrol Dial Transplant. 2010 Sep;25(9):2991-6
pubmed: 20237054
Clin Chem. 2019 Feb;65(2):349-350
pubmed: 30459169
Nephrol Dial Transplant. 2003 Oct;18(10):2170-4
pubmed: 13679498