Hypertension-based clinical risk strategies for detecting microalbuminuria in diabetes.
BACKGROUND
Microalbuminuria screening to identify patients at risk of diabetic nephropathy is widely accepted.


OBJECTIVE
To investigate whether blood-pressure-based strategies can identify such patients without the need for microalbuminuria testing.


METHODS
Spot urine for albumin/creatinine ratios was performed in all patients over an 18-month period. The performance of four combinations of clinical models, based on existing triggers for anti-hypertensive intervention (prior use and/or existing systolic BP exceeding 140 or 160 mmHg and/or dipstick proteinuria exceeding 1+ or 2+) was evaluated at microalbuminuria thresholds of 3.5 and 10 mg/mmol. The models were ranked 1 to 4, based on their escalating relative strengths in predicting need for intervention.


RESULTS
Of 3748 patients, 1257 (34%) or 739 (20%) exceeded microalbuminuria thresholds of 3.5 or 10 mg/mmol. All four models predicted microalbuminuria risk (areas under ROC curves 0.60-0.77, all p < 0.001). The models (1-4) identified 2220, 2465, 2803 or 2937 for intervention, respectively, irrespective of microalbuminuria status, and missed 368, 232, 194 or 126 at 3.5 mg/mmol and 164, 87, 81 or 45 at 10 mg/mmol.


CONCLUSIONS
Clinical models using routinely measured parameters reduced the target population for microalbuminuria screening by 60-80%, missing 3-10% of patients with albumin/creatinine ratios exceeding 3.5 mg/mmol or 1-4% of those exceeding 10 mg/mmol.
Baskar
V
V
Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK. baskar@doctors.org.uk
Kamalakannan
D
D
Kiberd
B
B
Holland
M R
MR
Singh
B M
BM
D000419:Albuminuria / Q000209:etiology / Q000652:urine*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000652:urine; D012372:ROC Curve
D000959:Antihypertensive Agents