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Large-scale AI analysis reveals missed opportunities in albuminuria testing and disease-modifying therapy
Marnicq van Es1,2, Jonas Erzeel1,2, Michiel De Wever1,2
1Department of Cardiology, Ziekenhuis Oost-Limburg A.V., Genk, Belgium.
Insights
Urine albumin-to-creatinine ratio (UACR) testing for albuminuria is underutilized in cardiology, missing opportunities to treat cardio-kidney-metabolic disease. Increased UACR screening could improve patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Metabolic Disease Research
Background:
- Albuminuria is a critical biomarker for chronic kidney disease (CKD) and predicts cardiovascular and renal events.
- Despite guidelines, urine albumin-to-creatinine ratio (UACR) testing is underused in cardiology settings.
- Cardio-kidney-metabolic (CKM) disease management is hindered by low albuminuria detection rates.
Purpose of the Study:
- To evaluate the adoption of UACR testing in cardiology.
- To estimate the prevalence of undiagnosed albuminuria in patients with CKM disease.
- To assess the utilization of disease-modifying therapies in this patient population.
Main Methods:
- A retrospective cohort study analyzed data from 77,351 adult cardiology patients (2019-2024).
- Data were extracted using an AI-driven platform (CTcue).
- Albuminuria was defined as UACR ≥30 mg/g; weighted logistic regression estimated prevalence in untested patients.
Main Results:
- Only 8.9% of patients had a recorded UACR, with 46.4% testing positive for albuminuria.
- Low testing rates were observed in high-risk groups: diabetes (29.9%), heart failure (21.7%), and hypertension (13.7%).
- Predicted albuminuria prevalence in untested patients was 36.6%, rising to 70.0% in those with eGFR <30 mL/min/1.73m²; disease-modifying therapy use was low.
Conclusions:
- Albuminuria is significantly underdetected in cardiology, potentially leading to underuse of effective CKM therapies.
- Systematic UACR screening and structured treatment protocols are recommended to improve CKM disease management.
- Closing the detection gap for albuminuria can enhance cardiovascular and renal outcomes.
Background:
Albuminuria is a key diagnostic and prognostic biomarker of chronic kidney disease (CKD), associated with adverse cardiovascular and renal outcomes. Despite guideline recommendations, urine albumin-to-creatinine ratio (UACR) testing is infrequently performed in cardiology. This study assessed the uptake of UACR testing, the estimated prevalence of undiagnosed albuminuria, and the use of disease-modifying therapies in patients with cardio-kidney-metabolic (CKM) disease.
Methods:
We conducted a retrospective cohort study of all adults seen at the cardiology department of a tertiary referral center between 2019-2024. Data were extracted using CTcue, an AI-driven platform. Albuminuria was defined as UACR ≥30 mg/g. A weighted logistic regression model estimated albuminuria prevalence in untested patients.
Results:
Among 77,351 patients (44.8% female, mean age 64.4 years), only 8.9% had a recorded UACR, of whom 46.4% had albuminuria. Testing rates were low across high-risk groups: 29.9% in diabetes, 21.7% in heart failure, and 13.7% in hypertension. In untested patients, the predicted prevalence of albuminuria was 36.6%, and highest in those with eGFR <30 mL/min/1.73m2 (70.0%), heart failure (47.8%), or diabetes (46.8%). Use of disease-modifying therapies was low, even among patients with confirmed albuminuria. In patients with documented vs predicted albuminuria, 43.0% vs 39.1% received renin-angiotensin system inhibitors, 12.8% vs 5.7% received SGLT2 inhibitors, and <1% in both groups received finerenone.
Conclusions:
Albuminuria is substantially underdetected in cardiology practice, possibly contributing to underuse of effective CKM therapies. Systematic UACR screening with structured treatment protocols may help close this gap and improve outcomes for patients with CKM disease.
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