Follow-up albuminuria testing low after initial abnormal protein dipstick result
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Key takeaways:
- Of evaluated patients with urine dipstick testing, 13% had an abnormal T1 protein test result.
- The cumulative 1-year incidence of follow-up albuminuria testing was 6.7%.
Follow-up albuminuria testing can be an important step in kidney care following initial abnormal results from a urine protein dipstick test, according to an analysis of health records.
“Accurate albuminuria quantification is crucial for early chronic kidney disease detection and management, and routine testing for albuminuria is recommended for persons with diabetes, CKD and hypertension,” Yunwen Xu, MHS, of the Johns Hopkins Bloomberg School of Public Health department of epidemiology, wrote with colleagues. “Evidence-based prescription of renin–angiotensin system inhibitors, glucagon-like peptide-1, receptor agonists, sodium-glucose cotransporter-2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists relies on the level of albuminuria. However, albuminuria testing rates remain extremely low.”
Researchers analyzed data from electronic health records in the Optum Labs Data Warehouse database on 1,042,740 patients across 33 U.S. health systems to assess follow-up albuminuria testing after an initial abnormal protein dipstick test result. Nonpregnant adults who had at least one outpatient visit and serum creatinine assessment in 2021 were included in the study.
An abnormal result was considered 1+ or greater protein in the absence of positive results for leukocyte esterase or nitrites.
Of patients with urine dipstick testing, 7,967 or 13% had an abnormal T1 protein dipstick test result, and 6.7% of those had follow-up albumin-to-creatinine or protein-creatinine ratio assessment within the following 1 year. The follow-up rate was 4% for those with normal baseline results.
Follow-up test rates rose with higher values on the initial abnormal test, according to the researchers. Those rates were 6.3%, 7.3% and 8% for 1+, 2+ and 3+ or greater protein, respectively. Follow-up testing was more common for patients with diabetes, at a rate of 16.6% vs. a rate of 3.8% those without; 86% of follow-up albuminuria assessment was done with albumin-to-creatinine ratio testing.
Of the patients with initial abnormal results who had follow-up testing, 43.3% had a positive result, and the rate of confirmatory albuminuria increased with higher baseline protein levels: 36.3% for 1+ protein, 53% for 2+ protein and 64.9% for 3+ or greater protein.
Percentages with albuminuria were similar for patients with and without diabetes, Xu and colleagues found. Results were consistent when requiring two albuminuria results.
“There is a crucial need for follow-up with albumin-to-creatinine testing, which offers greater accuracy and is essential for determining whether to initiate cardiorenal protective therapies,” the researchers wrote. “Improved education on the necessity of follow-up albuminuria quantification and the implementation of guideline-recommended albumin-to-creatinine testing would benefit many patients through earlier detection and treatment of albuminuric CKD.”
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