Microalbuminuria screening for detecting chronic kidney disease in the general population: a systematic review

Microalbuminuria screening is widely used in high-risk populations but seldom used in the general population for detecting chronic kidney disease (CKD). Systematic reviews focused on screening for CKD are rare, and the issues about microalbuminuria screening in the general population have never been reviewed. We systematically reviewed studies regarding microalbuminuria screening and evaluated the benefits and harms of this screening method in the general population.

We systematically searched MEDLINE, PubMed, and the Cochrane Library for English articles published from January 1970 to 13 December 2011. Quality assessments were performed using the QUADAS tool or the Drummond's 10-point checklist. Due to the high heterogeneity of the study designs, meta-analysis for the study results was not possible. Therefore, we performed a narrative synthesis.

Six articles from four studies made up our final study population, with four articles evaluating different screening methodologies and two reporting cost-effectiveness analyses. The qualities of the included articles ranged from fair to high. Spot urine albumin concentration and spot urine albumin:creatinine ratio had a similar diagnostic performance for microalbuminuria screening in the general population. Screening for microalbuminuria in high-risk populations, such as patients with diabetes, hypertension, or old age, was cost-effective. However, there was no consensus regarding the cost-effectiveness for microalbuminuria screening in the general population.

Microalbuminuria screening in high-risk populations is cost-effective. However, the cost-effectiveness of screening for microalbuminuria in the general population deserves further study. To keep costs low, spot urine albumin concentration may be preferable than the albumin:creatinine ratio.