Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis

Keiichi Sumida; Girish N. Nadkarni; Morgan E. Grams; Yingying  Sang; Shoshana H. Ballew; Josef Coresh; Kunihiro Matsushita; Aditya Surapaneni; Nigel Brunskill; Steven J. Chadban; Alex R. Chang; Massimo  Cirillo; Kenn B. Daratha; Ron T. Gansevoort; Amit X. Garg; Licia Iacoviello; Takamasa Kayama; Tsuneo Konta; Csaba P. Kovesdy; James Lash; Brian J. Lee; Rupert Major; Marie Metzger; Katsuyuki Miura; David M.J. Naimark; Robert G. Nelson; Simon Sawhney; Nikita Stempniewicz; Mila Tang; Raymond R. Townsend; Jamie P. Traynor; Jose M. Valdivielso; Jack Wetzels; Kevan R. Polkinghorne; Hiddo J.L. Heerspink; the Chronic Kidney Disease Prognosis Consortium

doi:10.7326/M20-0529

Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis

Keiichi Sumida, Girish N. Nadkarni, Morgan E. Grams^* (Corresponding Author), Yingying Sang, Shoshana H. Ballew, Josef Coresh^* (Corresponding Author), Kunihiro Matsushita, Aditya Surapaneni, Nigel Brunskill, Steven J. Chadban, Alex R. Chang, Massimo Cirillo, Kenn B. Daratha, Ron T. Gansevoort, Amit X. Garg, Licia Iacoviello, Takamasa Kayama, Tsuneo Konta, Csaba P. Kovesdy, James LashBrian J. Lee, Rupert Major, Marie Metzger, Katsuyuki Miura, David M.J. Naimark, Robert G. Nelson, Simon Sawhney, Nikita Stempniewicz, Mila Tang, Raymond R. Townsend, Jamie P. Traynor, Jose M. Valdivielso, Jack Wetzels, Kevan R. Polkinghorne, Hiddo J.L. Heerspink, the Chronic Kidney Disease Prognosis Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

BACKGROUND: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.

OBJECTIVE: To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.

DESIGN: Individual participant-based meta-analysis.

SETTING: 12 research and 21 clinical cohorts.

PARTICIPANTS: 919 383 adults with same-day measures of ACR and PCR or dipstick protein.

MEASUREMENTS: Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).

RESULTS: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.

LIMITATION: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.

CONCLUSION: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.

PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.

Original language	English
Pages (from-to)	426-435
Number of pages	13
Journal	Annals of Internal Medicine
Volume	173
Issue number	6
Early online date	14 Jul 2020
DOIs	https://doi.org/10.7326/M20-0529
Publication status	Published - 15 Sep 2020

Keywords

GLOMERULAR-FILTRATION-RATE
COLLABORATIVE METAANALYSIS
DIAGNOSTIC-ACCURACY
GENERAL-POPULATION
RENAL-DISEASE
ALL-CAUSE
RISK
MORTALITY
ASSOCIATION
PREDICTION

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Sumida, K., Nadkarni, G. N., Grams, M. E., Sang, Y., Ballew, S. H., Coresh, J., Matsushita, K., Surapaneni, A., Brunskill, N., Chadban, S. J., Chang, A. R., Cirillo, M., Daratha, K. B., Gansevoort, R. T., Garg, A. X., Iacoviello, L., Kayama, T., Konta, T., Kovesdy, C. P., ... the Chronic Kidney Disease Prognosis Consortium (2020). Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis. Annals of Internal Medicine, 173(6), 426-435. https://doi.org/10.7326/M20-0529

Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant–Based Meta-analysis. / Sumida, Keiichi; Nadkarni, Girish N.; Grams, Morgan E. (Corresponding Author); Sang, Yingying ; Ballew, Shoshana H.; Coresh, Josef (Corresponding Author); Matsushita, Kunihiro; Surapaneni, Aditya; Brunskill, Nigel; Chadban, Steven J.; Chang, Alex R.; Cirillo, Massimo ; Daratha, Kenn B.; Gansevoort, Ron T.; Garg, Amit X.; Iacoviello, Licia; Kayama, Takamasa; Konta, Tsuneo; Kovesdy, Csaba P.; Lash, James; Lee, Brian J.; Major, Rupert; Metzger, Marie; Miura, Katsuyuki; Naimark, David M.J.; Nelson, Robert G.; Sawhney, Simon; Stempniewicz, Nikita; Tang, Mila; Townsend, Raymond R.; Traynor, Jamie P.; Valdivielso, Jose M.; Wetzels, Jack; Polkinghorne, Kevan R.; Heerspink, Hiddo J.L.; the Chronic Kidney Disease Prognosis Consortium.

In: Annals of Internal Medicine, Vol. 173, No. 6, 15.09.2020, p. 426-435.

Research output: Contribution to journal › Article › peer-review

Sumida, K, Nadkarni, GN, Grams, ME, Sang, Y, Ballew, SH, Coresh, J, Matsushita, K, Surapaneni, A, Brunskill, N, Chadban, SJ, Chang, AR, Cirillo, M, Daratha, KB, Gansevoort, RT, Garg, AX, Iacoviello, L, Kayama, T, Konta, T, Kovesdy, CP, Lash, J, Lee, BJ, Major, R, Metzger, M, Miura, K, Naimark, DMJ, Nelson, RG, Sawhney, S, Stempniewicz, N, Tang, M, Townsend, RR, Traynor, JP, Valdivielso, JM, Wetzels, J, Polkinghorne, KR, Heerspink, HJL & the Chronic Kidney Disease Prognosis Consortium 2020, 'Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis', Annals of Internal Medicine, vol. 173, no. 6, pp. 426-435. https://doi.org/10.7326/M20-0529

Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J et al. Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis. Annals of Internal Medicine. 2020 Sep 15;173(6):426-435. https://doi.org/10.7326/M20-0529

Sumida, Keiichi ; Nadkarni, Girish N. ; Grams, Morgan E. ; Sang, Yingying ; Ballew, Shoshana H. ; Coresh, Josef ; Matsushita, Kunihiro ; Surapaneni, Aditya ; Brunskill, Nigel ; Chadban, Steven J. ; Chang, Alex R. ; Cirillo, Massimo ; Daratha, Kenn B. ; Gansevoort, Ron T. ; Garg, Amit X. ; Iacoviello, Licia ; Kayama, Takamasa ; Konta, Tsuneo ; Kovesdy, Csaba P. ; Lash, James ; Lee, Brian J. ; Major, Rupert ; Metzger, Marie ; Miura, Katsuyuki ; Naimark, David M.J. ; Nelson, Robert G. ; Sawhney, Simon ; Stempniewicz, Nikita ; Tang, Mila ; Townsend, Raymond R. ; Traynor, Jamie P. ; Valdivielso, Jose M. ; Wetzels, Jack ; Polkinghorne, Kevan R. ; Heerspink, Hiddo J.L. ; the Chronic Kidney Disease Prognosis Consortium. / Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant–Based Meta-analysis. In: Annals of Internal Medicine. 2020 ; Vol. 173, No. 6. pp. 426-435.

@article{dae607d3e855450983e7315c63709604,

title = "Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-analysis",

abstract = "BACKGROUND: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.OBJECTIVE: To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.DESIGN: Individual participant-based meta-analysis.SETTING: 12 research and 21 clinical cohorts.PARTICIPANTS: 919 383 adults with same-day measures of ACR and PCR or dipstick protein.MEASUREMENTS: Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).RESULTS: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.LIMITATION: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.CONCLUSION: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.",

keywords = "GLOMERULAR-FILTRATION-RATE, COLLABORATIVE METAANALYSIS, DIAGNOSTIC-ACCURACY, GENERAL-POPULATION, RENAL-DISEASE, ALL-CAUSE, RISK, MORTALITY, ASSOCIATION, PREDICTION",

author = "Keiichi Sumida and Nadkarni, {Girish N.} and Grams, {Morgan E.} and Yingying Sang and Ballew, {Shoshana H.} and Josef Coresh and Kunihiro Matsushita and Aditya Surapaneni and Nigel Brunskill and Chadban, {Steven J.} and Chang, {Alex R.} and Massimo Cirillo and Daratha, {Kenn B.} and Gansevoort, {Ron T.} and Garg, {Amit X.} and Licia Iacoviello and Takamasa Kayama and Tsuneo Konta and Kovesdy, {Csaba P.} and James Lash and Lee, {Brian J.} and Rupert Major and Marie Metzger and Katsuyuki Miura and Naimark, {David M.J.} and Nelson, {Robert G.} and Simon Sawhney and Nikita Stempniewicz and Mila Tang and Townsend, {Raymond R.} and Traynor, {Jamie P.} and Valdivielso, {Jose M.} and Jack Wetzels and Polkinghorne, {Kevan R.} and Heerspink, {Hiddo J.L.} and {the Chronic Kidney Disease Prognosis Consortium}",

note = "Financial Support: The CKD-PC Data Coordinating Center is funded in part by a program grant from the U.S. National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446). Various sources have supported enrollment and data collection, including laboratory measurements and follow-up, in the collaborating cohorts of the CKD-PC. These funding sources include government agencies, such as national institutes of health and medical research councils, as well as the foundations and industry sponsors listed in Supplemental Appendix 3 (available at Annals.org).",

year = "2020",

month = sep,

day = "15",

doi = "10.7326/M20-0529",

language = "English",

volume = "173",

pages = "426--435",

journal = "Annals of Internal Medicine",

issn = "0003-4819",

publisher = "American College of Physicians",

number = "6",

}

TY - JOUR

T1 - Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis

T2 - An Individual Participant–Based Meta-analysis

AU - Sumida, Keiichi

AU - Nadkarni, Girish N.

AU - Grams, Morgan E.

AU - Sang, Yingying

AU - Ballew, Shoshana H.

AU - Coresh, Josef

AU - Matsushita, Kunihiro

AU - Surapaneni, Aditya

AU - Brunskill, Nigel

AU - Chadban, Steven J.

AU - Chang, Alex R.

AU - Cirillo, Massimo

AU - Daratha, Kenn B.

AU - Gansevoort, Ron T.

AU - Garg, Amit X.

AU - Iacoviello, Licia

AU - Kayama, Takamasa

AU - Konta, Tsuneo

AU - Kovesdy, Csaba P.

AU - Lash, James

AU - Lee, Brian J.

AU - Major, Rupert

AU - Metzger, Marie

AU - Miura, Katsuyuki

AU - Naimark, David M.J.

AU - Nelson, Robert G.

AU - Sawhney, Simon

AU - Stempniewicz, Nikita

AU - Tang, Mila

AU - Townsend, Raymond R.

AU - Traynor, Jamie P.

AU - Valdivielso, Jose M.

AU - Wetzels, Jack

AU - Polkinghorne, Kevan R.

AU - Heerspink, Hiddo J.L.

AU - the Chronic Kidney Disease Prognosis Consortium

N1 - Financial Support: The CKD-PC Data Coordinating Center is funded in part by a program grant from the U.S. National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446). Various sources have supported enrollment and data collection, including laboratory measurements and follow-up, in the collaborating cohorts of the CKD-PC. These funding sources include government agencies, such as national institutes of health and medical research councils, as well as the foundations and industry sponsors listed in Supplemental Appendix 3 (available at Annals.org).

PY - 2020/9/15

Y1 - 2020/9/15

N2 - BACKGROUND: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.OBJECTIVE: To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.DESIGN: Individual participant-based meta-analysis.SETTING: 12 research and 21 clinical cohorts.PARTICIPANTS: 919 383 adults with same-day measures of ACR and PCR or dipstick protein.MEASUREMENTS: Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).RESULTS: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.LIMITATION: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.CONCLUSION: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.

AB - BACKGROUND: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.OBJECTIVE: To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.DESIGN: Individual participant-based meta-analysis.SETTING: 12 research and 21 clinical cohorts.PARTICIPANTS: 919 383 adults with same-day measures of ACR and PCR or dipstick protein.MEASUREMENTS: Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).RESULTS: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.LIMITATION: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.CONCLUSION: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.

KW - GLOMERULAR-FILTRATION-RATE

KW - COLLABORATIVE METAANALYSIS

KW - DIAGNOSTIC-ACCURACY

KW - GENERAL-POPULATION

KW - RENAL-DISEASE

KW - ALL-CAUSE

KW - RISK

KW - MORTALITY

KW - ASSOCIATION

KW - PREDICTION

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DO - 10.7326/M20-0529

M3 - Article

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VL - 173

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JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

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