Diagnostic Performance of Random Urine Samples Using Albumin Concentration vs. Ratio of Albumin to Creatinine for Microalbuminuria Screening in Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis

Study Questions:

What is the diagnostic performance of the urine albumin concentration (UAC) versus the ratio of albumin to creatinine (ACR) in random urine samples for microalbuminuria screening among patients with diabetes mellitus (DM)?

Methods:

Electronic literature searches of PubMed, MEDLINE, and Scopus for English-language publications from the earliest available date of indexing through July 31, 2012, were conducted. Clinical studies assessing the UAC or the ACR of random urine samples in detecting the presence of microalbuminuria among patients with DM using a urinary albumin excretion rate of 30-300 mg/d in 24-hour timed urine collections as the criterion standard were selected for analysis. Bivariate random-effects models for analysis and pooling of the diagnostic performance measures across studies, as well as comparisons between different screening tests were performed. The primary endpoint was the diagnostic performance measures of the UAC or the ACR in random urine samples, as well as comparisons between them.

Results:

The investigators identified 14 studies, with a total of 2,078 patients; nine studies reported on the UAC, and 12 studies reported on the ACR. Meta-analysis showed pooled sensitivities of 0.85 and 0.87 for the UAC and the ACR, respectively, and pooled specificities of 0.88 and 0.88, respectively. No differences in sensitivity (p = 0.70), specificity (p = 0.63), or diagnostic odds ratios (p = 0.59) between the UAC and the ACR were found. The time point of urine collection did not affect the diagnostic performance of either test.

Conclusions:

The authors concluded that the UAC and the ACR yielded high sensitivity and specificity for the detection of microalbuminuria.

Perspective:

This systematic review and meta-analysis comparing the diagnostic performance of different tests of random urine samples for microalbuminuria screening in patients with DM suggest that the UAC, which has high sensitivity and specificity, is comparable to the ACR for accurate detection of microalbuminuria among patients with DM. Because the diagnostic performance of the UAC appears comparable to that of the ACR, the UAC of random urine samples may become the screening tool of choice for individuals with DM, considering the rising incidence of DM globally and the health care resource constraints in many countries.

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Odds Ratio, Urinalysis, Tetrahydroisoquinolines, Risk Factors, Diabetic Nephropathies, Creatinine, Urine Specimen Collection, Metabolic Syndrome X, Incidence, Biological Markers, Troponin I, Diabetes Mellitus, MEDLINE


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