TY - JOUR
T1 - Creatinine-based glomerular filtration rates and microalbuminuria for detecting metabolic abnormalities in US adults
T2 - The National Health and Nutrition Examination Survey 2003-2004
AU - Foley, Robert N.
AU - Wang, Changchun
AU - Ishani, Areef
AU - Ibrahim, Hassan N.
AU - Collins, Allan J.
PY - 2008/4
Y1 - 2008/4
N2 - Background/Aims: Guidelines suggest searching for metabolic complications of chronic kidney disease when glomerular filtration rates (GFR) or urinary albumin tests are abnormal. This study aimed to quantify diagnostic test characteristics of these measures for detecting metabolic abnormalities. Methods: Subjects were participants aged ≥20 years (n = 7,778) in the US National Health and Nutrition Examination Survey 2003-2004. Low GFR was defined as creatinine-based estimate <60 ml/min per 1.73 m2; abnormal urinary albumin-creatinine ratio as ≥20 mg/dl in men, ≥30 mg/dl in women; and metabolic abnormalities as abnormal potassium, hemoglobin, bicarbonate, phosphorus, or parathyroid hormone levels. Results: Of adults, 5.66% had low GFR and 8.14% abnormal urinary albumin-creatinine ratio. Overall, 15.09% had ≥ one metabolic abnormality, as did 34.07% with low GFR (p < 0.0001) and 24.27% with abnormal urinary albumin-creatinine ratio (p = 0.0021). Considered as a diagnostic test, the sensitivity, specificity, and positive and negative predictive values of low GFR for detecting ≥1 metabolic abnormality were 0.13, 0.96, 0.34, and 0.86, respectively. Corresponding values for abnormal urinary albumin-creatinine ratio were 0.13, 0.92, 0.24, and 0.86. Conclusions: A policy of searching for metabolic complications in every adult with low GFR or microalbuminuria has limited diagnostic yield.
AB - Background/Aims: Guidelines suggest searching for metabolic complications of chronic kidney disease when glomerular filtration rates (GFR) or urinary albumin tests are abnormal. This study aimed to quantify diagnostic test characteristics of these measures for detecting metabolic abnormalities. Methods: Subjects were participants aged ≥20 years (n = 7,778) in the US National Health and Nutrition Examination Survey 2003-2004. Low GFR was defined as creatinine-based estimate <60 ml/min per 1.73 m2; abnormal urinary albumin-creatinine ratio as ≥20 mg/dl in men, ≥30 mg/dl in women; and metabolic abnormalities as abnormal potassium, hemoglobin, bicarbonate, phosphorus, or parathyroid hormone levels. Results: Of adults, 5.66% had low GFR and 8.14% abnormal urinary albumin-creatinine ratio. Overall, 15.09% had ≥ one metabolic abnormality, as did 34.07% with low GFR (p < 0.0001) and 24.27% with abnormal urinary albumin-creatinine ratio (p = 0.0021). Considered as a diagnostic test, the sensitivity, specificity, and positive and negative predictive values of low GFR for detecting ≥1 metabolic abnormality were 0.13, 0.96, 0.34, and 0.86, respectively. Corresponding values for abnormal urinary albumin-creatinine ratio were 0.13, 0.92, 0.24, and 0.86. Conclusions: A policy of searching for metabolic complications in every adult with low GFR or microalbuminuria has limited diagnostic yield.
KW - Chronic kidney disease
KW - Creatinine
KW - Glomerular filtration rate
KW - Microalbuminuria
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U2 - 10.1159/000112808
DO - 10.1159/000112808
M3 - Article
C2 - 18097135
AN - SCOPUS:41849124492
SN - 0250-8095
VL - 28
SP - 431
EP - 437
JO - American Journal of Nephrology
JF - American Journal of Nephrology
IS - 3
ER -