QJM Advance Access originally published online on May 6, 2005
QJM 2005 98(6):427-433; doi:10.1093/qjmed/hci066
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Hypertension-based clinical risk strategies for detecting microalbuminuria in diabetes
From the 1Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK, and 2Dalhousie University, Nova Scotia, Canada
Address correspondence to Dr V. Baskar, 7 Coven Mill Close, Coven, Wolverhampton WV9 5HX. e-mail: baskar{at}doctors.org.uk
Received 23 November 2004 and in revised form 17 March 2005
Background: Microalbuminuria screening to identify patients at risk of diabetic nephropathy is widely accepted.
Aim: 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.
Discussion: 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.