Using Risk Assessment to Improve Screening for Albuminuria among US Adults without Diabetes

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• Current guidelines recommend annual albuminuria screening only for individuals with diabetes mellitus (DM).
• There is a lack of guidance for albuminuria screening in individuals with other significant chronic kidney disease (CKD) risk factors, such as hypertension or a family history of kidney disease.
• This study aimed to develop a predictive risk score for albuminuria in non-diabetic adults.

Purpose of the Study:

• To develop and validate a risk score for predicting albuminuria in adults without diabetes.
• To facilitate earlier detection and management of chronic kidney disease (CKD) in a broader population.
• To identify key risk factors associated with albuminuria in the absence of diabetes.

Main Methods:

• Analysis of data from 44,322 non-diabetic participants aged 18+ from the National Health and Nutrition Examination Surveys (1999-2020).
• Survey-weighted logistic regression was employed to assess associations between individual characteristics and albuminuria (urinary albumin to creatinine ratio [UACR] ≥ 30 mg/g).
• The dataset was divided into development and validation sets, with C-statistics used for model fit assessment.

Main Results:

• The prevalence of albuminuria was 9.7% in the US adult population without diabetes.
• Significant predictors of albuminuria included female sex, non-Hispanic Black race, smoking, low estimated glomerular filtration rate (eGFR), hypertension, cardiovascular disease, prediabetes, low HDL cholesterol, and high uric acid levels.
• A risk score model achieved a C-statistic of 0.756 (development) and 0.752 (validation), with a 5% probability threshold capturing 85% of individuals with albuminuria.

Conclusions:

• A risk score framework for albuminuria screening in individuals without diabetes could aid in earlier CKD detection and management.
• Further longitudinal studies are needed to confirm the utility and cost-effectiveness of this risk score approach.
• This approach may help bridge the gap in current screening recommendations for CKD risk factors beyond diabetes.