ArticleCanadian family physician Medecin de famille canadien2018
Chronic kidney disease in type 2 diabetes: Does an abnormal urine albumin-to-creatinine ratio need to be retested?
Article in Canadian family physician Medecin de famille canadien, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 7 citations in OpenAlex.
- Modulating Renal Fibrosis: The Emerging Role of Hepatocyte Growth Factor.International journal of nephrology · 2026Review
- Clinical use of polygenic scores in type 2 diabetes: challenges and possibilities.Diabetologia · 2025Review
- Variability and misclassification of albuminuria in patients with type 2 diabetes mellitus.Scientific reports · 2025Article
- Prevalence of diabetic retinopathy and its risk factors in rural patients with type 2 diabetes referring to Beijing Huairou Hospital, China.BMC ophthalmology · 2024Article
- What methods are being used to create an evidence base on the use of laboratory tests to monitor long-term conditions in primary care? A scoping review.Family practice · 2020Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the positive predictive value (PPV) of a single random abnormal urine albumin-to-creatinine ratio (ACR) compared with repeat test results in patients with type 2 diabetes to diagnose chronic kidney disease (CKD).
designRetrospective, longitudinal secondary data analysis using Calgary Laboratory Services data.
settingCalgary, Alta.
participantsPatients aged 21 and older with a new diagnosis of diabetes in the study period from January 2008 to December 2015 and with a first abnormal urine ACR followed by another ACR test completed within 120 days.
main outcome measuresThe PPV of an abnormal urine ACR (2 to 20 mg/mmol) to diagnose CKD was calculated. A test result was considered a true positive if a subsequent positive test result (≥ 2 mg/mmol) was identified within 120 days of the first positive test result and a false positive if 2 subsequent negative test results were identified within the same time period. The relationship between the first and second urine ACR values to assess the probability of the second urine ACR being abnormal (≥ 2 mg/mmol) based on the values of the first abnormal urine ACR was also explored.
resultsThe PPV of the first abnormal urine ACR between 2 and 20 mg/mmol to diagnose CKD was calculated at 96.80% (95% CI 95.37% to 98.21%). Additionally, there was increased predictive probability of the second urine ACR being abnormal at higher values of the first urine ACR (2 to 20 mg/mmol). The data were further analyzed to exclude test results with a new or changed prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker medications around the time of the first urine ACR test to focus results on screening and not treatment response. With these exclusions, the PPV for first urine ACR between 2 and 20 mg/mmol to diagnose CKD was calculated as 96.23% (95% CI 94.13% to 98.32%).
conclusionThe first random abnormal urine ACR has a good PPV for the diagnosis of CKD in patients with type 2 diabetes, so multiple random urine ACR tests might not be necessary to diagnose patients with type 2 diabetes as having persistent microalbuminuria and CKD. A simpler diagnostic model for diagnosing renal disease might improve patient compliance, efficiency of testing, and implementation of health interventions. Reduced testing would also be expected to result in reduced cost from a health care expenditure perspective.
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Identifiers
30315036PMC6184958W2901170441What OpenQuestion holds
Registered trials
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