Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/9406
Title: Albumin to creatinine ratio: a screening test with limitations.
Authors: Houlihan, Christine A;Tsalamandris, Con;Akdeniz, Aysel;Jerums, George
Affiliation: Endocrine Unit and Department of Medicine, University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Issue Date: 1-Jun-2002
Citation: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation; 39(6): 1183-9
Abstract: The aim of this study is to assess the effects of age on (1) the ability of a spot albumin-creatinine ratio (ACR) to accurately predict 24-hour albumin excretion rate (AER), and (2) the performance of spot ACR as a screening test for microalbuminuria. Three hundred fourteen patients with diabetes aged 18 to 84 years attending a tertiary outpatient clinic underwent one 24-hour urine collection and, immediately after completion, provided one fasting spot morning urine sample. Twenty-four-hour AER and spot ACR were determined. Performance of spot ACR was assessed according to age and sex. Fifty-three percent of men and 32% of women had an AER of 20 microg/min or greater. Multiple regression analysis showed age was an independent predictor of spot ACR. For an AER of 20 microg/min for patients in the age range of 40 to 80 years, there was an increase in corresponding values for spot ACR from 18.2 mg/g (95% confidence interval [CI], 15.6 to 21.3) to 32.5 mg/g (95% CI, 27.5 to 38.4) in men and from 22.1 mg/g (95% CI, 18.0 to 27.1) to 56.4 mg/g (95% CI, 47.2 to 67.4) in women. Using ACR cutoff values of 22.1 mg/g or greater and 30.9 mg/g or greater in conventional units (equivalent to > or =2.5 and > or =3.5 mg/mmol in SI units) in men and women, the spot ACR provided high sensitivities (men, 95.7%; women, 93.35%) and had excellent receiver operator characteristic curves, respectively. However, the spot ACR false-positive rate increased with age from 15.9% (age, 40 to 65 years) to 31.8% (>65 years) in men and from 10.5% (age, 45 to 65 years) to 28.3% (>65 years) in women. Spot ACR is a good screening test for microalbuminuria, but a poor predictor of quantitative AER, and should not be used as a diagnostic test. The increase in spot ACR relative to 24-hour AER with age supports the use of sex- and age-adjusted ACR cutoff values.
Internal ID Number: 12046029
URI: http://ahro.austin.org.au/austinjspui/handle/1/9406
URL: http://www.ncbi.nlm.nih.gov/pubmed/12046029
Type: Journal Article
Subjects: Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Albuminuria.diagnosis.urine
Creatinine.urine
Diabetic Nephropathies.diagnosis.urine
Female
Humans
Male
Mass Screening.methods.standards
Middle Aged
ROC Curve
Regression Analysis
Sensitivity and Specificity
Sex Factors
Appears in Collections:Journal articles

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