title: Comparison between urine albumin-to-creatinine ratio and urine protein dipstick testing for prevalence and ability to predict the risk for chronic kidney disease in the general population (Iwate-KENCO study): a prospective community-based cohort study.
abstract: This study compared the combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) vs. eGFR and urine protein reagent strip testing to determine chronic kidney disease (CKD) prevalence, and each method's ability to predict the risk for cardiovascular events in the general Japanese population.
  
  
  
  Baseline data including eGFR, UACR, and urine dipstick tests were obtained from the general population (n = 22 975). Dipstick test results (negative, trace, positive) were allocated to three levels of UACR (<30, 30-300, >300), respectively. In accordance with Kidney Disease Improving Global Outcomes CKD prognosis heat mapping, the cohort was classified into four risk grades (green: grade 1; yellow: grade 2; orange: grade 3, red: grade 4) based on baseline eGFR and UACR levels or dipstick tests.
  
  
  
  During the mean follow-up period of 5.6 years, 708 new onset cardiovascular events were recorded. For CKD identified by eGFR and dipstick testing (dipstick test ≥ trace and eGFR <60 mL/min/1.73 m(2)), the incidence of CKD was found to be 9 % in the general population. In comparison to non-CKD (grade 1), although cardiovascular risk was significantly higher in risk grades ≥3 (relative risk (RR) = 1.70; 95 % CI: 1.28-2.26), risk predictive ability was not significant in risk grade 2 (RR = 1.20; 95 % CI: 0.95-1.52). When CKD was defined by eGFR and UACR (UACR ≥30 mg/g Cr and eGFR <60 mL/min/1.73 m(2)), prevalence was found to be 29 %. Predictive ability in risk grade 2 (RR = 1.41; 95 % CI: 1.19-1.66) and risk grade ≥3 (RR = 1.76; 95 % CI: 1.37-2.28) were both significantly greater than for non-CKD. Reclassification analysis showed a significant improvement in risk predictive abilities when CKD risk grading was based on UACR rather than on dipstick testing in this population (p < 0.001).
  
  
  
  Although prevalence of CKD was higher when detected by UACR rather than urine dipstick testing, the predictive ability for cardiovascular events from UACR-based risk grading was superior to that of dipstick-based risk grading in the general population.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. ori-aka@hotmail.co.jp.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Koeda
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Toshie
authors.initials: T
authors.lastname: Segawa
authors.affiliation: Iwate Health Service Association, Morioka, Japan.
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Ohta
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Tanno
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishibashi
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Itai
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Omama
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onoda
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: The Research Institute of Strategy for Prevention, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000652:urine*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003404:Creatinine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology*; D018570:Risk Assessment; D016482:Urinalysis / Q000379:methods
chemical_list: D003404:Creatinine
keywords: Cardiovascular disease; Renal function; Risk factor; Urine albumin-to-creatinine ratio; Urine dipstick test