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

Guidelines currently recommend annual screening for albuminuria only among persons with diabetes mellitus (DM). There is no guidance about albuminuria screening in those with other important risk factors for chronic kidney disease (CKD), such as hypertension and/or family history of kidney disease. We sought to create a risk score that predicts the likelihood of albuminuria in adults without diabetes to prompt earlier detection and management of CKD.

Data from 44,322 participants without diabetes, aged 18 + years from the National Health and Nutrition Examination Surveys 1999-2020 were analyzed. Survey-weighted logistic regression was used to assess associations between individual characteristics and presence of albuminuria (urinary albumin to creatinine ratio [UACR] ≥ 30 mg/g), including interaction terms, in three separate models. The sample was divided equally into development and validation data sets. C-statistics were used to assess model fit.

The prevalence of albuminuria was 9.7% in the US adult population. Higher odds of albuminuria among the non-diabetic population were observed in females, non-Hispanic Black, and smokers, as well as those with low eGFR, hypertension, cardiovascular disease, prediabetes, low HDL cholesterol, and high uric acid levels. Age showed a J-shaped relationship with albuminuria, with lowest odds for ages 25-64 years. The C-statistic was 0.756 for the developmental and 0.752 for the validation set of the final model. Using this model, screening individuals with a predicted probability of ≥ 5% would capture 85% of individuals with albuminuria.

These results suggest that it may be helpful to use a risk score framework for albuminuria screening in people without DM to encourage earlier detection and management of CKD. Longitudinal studies are warranted to confirm this approach along with evaluation of its cost effectiveness.