[en] OBJECTIVES: Severity of chronic kidney disease is defined by glomerular filtration rate (GFR) and albuminuria (ACR) by the KDIGO and are related to cardiovascular outcomes and end-stage-kidney-failure. However, proteinuria (PCR) is more often available than ACR in records. Recently, equations were developed to estimate ACR from PCR. We investigated their performances in our population.
METHODS: In the academic medical hospital of Liège, we retrospectively analysed same day measurement of ACR and PCR and staged them according to the KDIGO A1-A2-A3 categories. Analyser Roche Cobas (R) gathered 2,633 urinalysis (May 2018-May 2019) and analyser Abbott Alinity (A) 2,386 urinalysis (May 2019-March 2020). We compared the KDIGO staging of mACR and eACR obtained from Weaver's and Sumida's equations.
RESULTS: Median age was 63 [52;71]/64 [53;72] years old, 43/42% were female; 78/74% had diabetes; proportion of mACR-A1 was 65.6%/64.2%, A2 was 25.5%/25.5% and A3 was 8.8%/10.3% (Method R/A, respectively). Both equations gave similar distribution of KDIGO staging of eACR. Overall agreements were higher than 88% regardless of the analyser or of the equation. Performances in between equations were equivalent according to the multi-level AUC (multinomial logistic regression model).
CONCLUSIONS: Good concordance was observed between mACR and eACR regardless of the equation or of the analyser. No patient with an A3-measured ACR was estimated within the KDIGO A1 category. Though ACR should be measured when clinically needed, it may be reasonably estimated from the PCR through these equations, for epidemiologic retrospective studies or research purposes.
Disciplines :
Urology & nephrology Laboratory medicine & medical technology
Author, co-author :
Résimont, Guillaume ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
VRANKEN, Laura ; Centre Hospitalier Universitaire de Liège - CHU > > Secteur commun NDB
Pottel, Hans ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
JOURET, François ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
KRZESINSKI, Jean-Marie ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie
CAVALIER, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie ; Nephrology-Dialysis-Apheresis Department, University Hospital Caremeau, Nimes, France
Language :
English
Title :
Estimating urine albumin to creatinine ratio from protein to creatinine ratio using same day measurement: validation of equations.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
Matsushita, K, Coresh, J, Sang, Y, Chalmers, J, Fox, CS, Guallar, E, et al.. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2015;3:514-25. https://doi.org/10.1016/s2213-8587(15)00040-6.
Tangri, N, Stevens, LA, Griffith, J, Tighiouart, H, Djurdjev, O, Naimark, D, et al.. A predictive model for progression of chronic kidney disease to kidney failure. JAMA 2011;305:1553-9. https://doi.org/10.1001/jama.2011.451.
Résimont, G, Cavalier, E, Radermecker, RP, Delanaye, P. Albuminuria in diabetic patients: how to measure it?-a narrative review. J Lab Precis Med 2022;7:1-10.
Al-Wahsh, H, Lam, NN, Quinn, RR, Ronksley, PE, Sood, MM, Hemmelgarn, B, et al.. Calculated versus measured albumin-creatinine ratio to predict kidney failure and death in people with chronic kidney disease. Kidney Int 2022;Apr 7. https://doi.org/10.1016/j.kint.2022.02.034. [Epub ahead of print].
Weaver, RG, James, MT, Ravani, P, Weaver, CGW, Lamb, EJ, Tonelli, M, et al.. Estimating urine albumin-to-creatinine ratio from protein-to-creatinine ratio: development of Equations using Same-Day Measurements. J Am Soc Nephrol 2020;31:591-601. https://doi.org/10.1681/asn.2019060605.
Sumida, K, Nadkarni, GN, Grams, ME, Sang, Y, Ballew, SH, Coresh, J, et al.. 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. Ann Intern Med 2020;173:426-35. https://doi.org/10.7326/m20-0529.
Bachmann, LM, Nilsson, G, Bruns, DE, McQueen, MJ, Lieske, JC, Zakowski, JJ, et al.. State of the art for measurement of urine albumin: comparison of routine measurement procedures to isotope dilution tandem mass spectrometry. Clin Chem 2014;60:471-80. https://doi.org/10.1373/clinchem.2013.210302.
Jacobson, BE, Seccombe, DW, Katayev, A, Levin, A. A study examining the bias of albumin and albumin/creatinine ratio measurements in urine. Clin Chem Lab Med 2015;53:1737-43. https://doi.org/10.1515/cclm-2014-1105.
Flachaire, E, Damour, O, Bienvenu, J, Aouiti, T, Later, R. Assessment of the benzethonium chloride method for routine determination of protein in cerebrospinal fluid and urine. Clin Chem 1983;29:343-5. https://doi.org/10.1093/clinchem/29.2.343.
McElderry, LA, Tarbit, IF, Cassells-Smith, AJ. Six methods for urinary protein compared. Clin Chem 1982;28:356-60. https://doi.org/10.1093/clinchem/28.2.356.
Dube, J, Girouard, J, Leclerc, P, Douville, P. Problems with the estimation of urine protein by automated assays. Clin Biochem 2005;38:479-85. https://doi.org/10.1016/j.clinbiochem.2004.12.010.
Maisnar, V, Tichy, M, Stulik, J, Vavrova, J, Friedecky, B, Palicka, V, et al.. The problems of proteinuria measurement in urine with presence of Bence Jones protein. Clin Biochem 2011;44:403-5. https://doi.org/10.1016/j.clinbiochem.2011.01.008.
Martin, H. Laboratory measurement of urine albumin and urine total protein in screening for proteinuria in chronic kidney disease. Clin Biochem Rev 2011;32:97-102.
Shapiro, SS, Wilk, MB. An analysis of variance test for normality (complete samples). Biometrika 1965;52:591-611. https://doi.org/10.1093/biomet/52.3-4.591.
Hanley, JA, McNeil, BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29-36. https://doi.org/10.1148/radiology.143.1.7063747.
Van Der Velde, M, Matsushita, K, Coresh, J, Astor, BC, Woodward, M, Levey, A, et al.. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int 2011;79:1341-52. https://doi.org/10.1038/ki.2010.536.
Astor, BC, Matsushita, K, Gansevoort, RT, Van Der Velde, M, Woodward, M, Levey, AS, et al.. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int 2011;79:1331-40. https://doi.org/10.1038/ki.2010.550.
Matsushita, K, van der Velde, M, Astor, BC, Woodward, M, Levey, AS, de Jong, PE, et al.. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375:2073-81. https://doi.org/10.1016/S0140-6736(10)60674-5.
Gansevoort, RT, Matsushita, K, Van Der Velde, M, Astor, BC, Woodward, M, Levey, AS, et al.. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int 2011;80:93-104. https://doi.org/10.1038/ki.2010.531.
Jonsson, AJ, Lund, SH, Eriksen, BO, Palsson, R, Indridason, OS. The prevalence of chronic kidney disease in Iceland according to KDIGO criteria and age-adapted estimated glomerular filtration rate thresholds. Kidney Int 2020;98:1286-95. https://doi.org/10.1016/j.kint.2020.06.017.
Inker, LA, Astor, BC, Fox, CH, Isakova, T, Lash, JP, Peralta, CA, et al.. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 2014;63:713-35. https://doi.org/10.1053/j.ajkd.2014.01.416.
National Clinical Guideline Centre (UK). Chronic Kidney Disease (Partial Update): Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care. London, UK: National Institute for Health and Care Excellence; 2014.
Haute Autorité de Santé. Evaluation du rapport Albuminurie/Créatininurie dans le diagnostic de la maladie rénale chronique chez l'adulte; 2011. Available from https://www.has-sante.fr/jcms/c_1169049/fr/evaluation-du-rapport-albuminurie/creatininurie-dans-le-diagnostic-de-la-maladie-renale-chronique-chez-l-adulte-rapport-d-evaluation.
Résimont, G, Gadisseur, R, Lutteri, L, Krzesinski, J, Cavalier, E, Delanaye, P. Comment j'explore une protéinurie. Rev Med Liege 2018;73:519-25.
Seegmiller, JC, Miller, WG, Bachmann, LM. Moving toward standardization of urine albumin measurements. EJIFCC 2017;28:258-67.
Stempniewicz, N, Vassalotti, JA, Cuddeback, JK, Ciemins, E, Storfer-Isser, A, Sang, Y, et al.. Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 U.S. health care organizations. Diabetes Care 2021;44:2000-9. https://doi.org/10.2337/dc20-2715.
Jehn, U, Görlich, D, Reuter, S. The estimation formula for the urinary albumin-creatinine ratio based on the protein-creatinine ratio are not valid for a kidney transplant and a living donor cohort. J Am Soc Nephrol 2020;31:1915-6. https://doi.org/10.1681/asn.2020050545.
Weaver, RG, Tonelli, M, Lamb, EJ, Hemmelgarn, BR. Authors' reply. J Am Soc Nephrol 2020;31:1916-7. https://doi.org/10.1681/asn.2020050707.
