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Prevalence and Factors Associated with Albuminuria Screening Among High-Risk Adults in Saudi Arabia: A Retrospective
Mohamed A Albekery1, Mohammed Alnuhait2, Ibrahim S Alhomoud3
1Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia.
Insights
Albuminuria testing for early chronic kidney disease (CKD) detection is underused in Saudi Arabia. Patients with hypertension alone are least likely to be screened, indicating a need for improved CKD screening strategies.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Albuminuria is a critical early indicator of chronic kidney disease (CKD).
- Diabetes mellitus and hypertension are primary risk factors for CKD.
- Current guidelines recommend regular albuminuria testing in high-risk populations, but adherence is suboptimal.
Purpose of the Study:
- To evaluate the rate of albumin-to-creatinine ratio (ACR) testing in patients with diabetes mellitus and/or hypertension in Saudi Arabia.
- To identify factors associated with ACR testing adherence.
- To assess the prevalence of albuminuria among tested patients.
Main Methods:
- A retrospective study analyzed data from 516 adult patients with diabetes mellitus, hypertension, or both at a tertiary center in Saudi Arabia.
- Exclusion criteria included patients already diagnosed with CKD.
- The primary outcome measured was the overall rate of ACR testing.
Main Results:
- The overall ACR testing rate was 59.1%, with significant variations across subgroups (diabetes-only: 69.5%, diabetes with hypertension: 66.3%, hypertension-only: 19.3%).
- Factors associated with increased testing included higher HbA1c, more outpatient visits, and use of ARBs and SGLT-2 inhibitors.
- Hypertension-only patients were significantly less likely to be tested (AOR=0.14).
- Among those tested, 40% showed evidence of albuminuria (A2 or A3).
Conclusions:
- Albuminuria testing is underutilized in high-risk patient groups in Saudi Arabia, particularly among those with hypertension alone.
- A significant gap exists between clinical practice and established guidelines for CKD screening.
- Interventions are needed to enhance early CKD detection, especially within primary care settings.
Background:
Albuminuria is a key marker for the early detection of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Despite guideline recommendations for albuminuria testing in these high-risk populations, adherence remains suboptimal.
Methods:
A retrospective study was conducted at a tertiary center in Al-Ahsa, Saudi Arabia. Data were collected from the records of 516 adults with diabetes mellitus, hypertension, or both. Patients with CKD were excluded. The primary outcome was the rate of albumin-to-creatinine ratio (ACR) testing.
Results:
Among 516 patients (mean age 63.7 ± 7.6 years), the overall prevalence of ACR testing was 59.1%. Testing was highest in the diabetes-only subgroup (69.5%), followed by the diabetes with hypertension subgroup (66.3%), and lowest in the hypertension-only subgroup (19.3%) (p<0.001). Testing was more likely in patients with high HbA1c, more outpatient visits, and among individuals using angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. After adjustment, hypertension-only patients were less likely to be tested (adjusted odds ratio [AOR] = 0.14; 95% CI: 0.07-0.31), whereas the use of ARBs (AOR = 3.17; 95% CI: 1.69-5.93) and SGLT2 inhibitors (AOR = 3.00; 95% CI: 1.31-6.90) was independently associated with increased testing. Of those tested, 40% had albuminuria (A2 or A3).
Conclusion:
Albuminuria testing is substantially underutilized among high-risk patients in Saudi Arabia. Individuals with hypertension only are the least likely to undergo screening. This suggests a gap between clinical practice and guideline recommendations. These findings highlight the need for strategies to improve early CKD detection, particularly in primary care.
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