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.
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.
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DOI：
10.7326/m20-0529
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发表时间：
2020-09-15
影响因子：
39.2
通讯作者：
Chronic Kidney Disease Prognosis Consortium
中科院分区：
文献类型：
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作者：
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 RW;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;Chronic Kidney Disease Prognosis Consortium
白蛋白尿是慢性肾脏病（CKD）定义和分期的首选指标，但通常测量总尿蛋白或试纸蛋白。建立尿蛋白/肌酐比值（PCR）和试纸蛋白/尿白蛋白/肌酐比值（ACR）换算公式，并检验其在CKD筛查和分期中的诊断准确性。基于个体参与者的荟萃分析。12个研究队列和21个临床队列。919，383名成人在同一天测量ACR和PCR或试纸蛋白。为了CKD筛查（ACR ≥30 mg/g）和分期（A2：ACR 30-299 mg/g; A3：≥300 mg/g），开发并测试了将尿液PCR和试纸蛋白转换为ACR的公式。中位ACR为14 mg/g（队列5-25的第25至第75百分位数）。当PCR值<50 mg/g时，PCR与ACR之间的相关性不一致。对于较高的PCR值，PCR转换方程分别显示出中等灵敏度（91%; 75%; 87%）和特异性（87%; 89%; 98%）用于筛选（ACR >30 mg/g）和分类为A2和A3期。用于筛查ACR >30 mg/g和分类为A2和A3期的微量或更高、微量/+和++尿试纸类别分别具有中等灵敏度（62%; 36%; 78%）和高特异性（88%; 88%; 98%）。对于个体风险预测，使用PCR预测的ACR估计的2年4变量肾衰竭风险方程与使用观察到的ACR估计的2年4变量肾衰竭风险方程具有相似的区分度。ACR和PCR定量的不同方法;不一定是相同的尿样。尿ACR是白蛋白尿的首选指标;然而，当ACR不可用时，通过PCR或尿试纸蛋白预测ACR可能有助于CKD筛查、分期和预后。NIDDK和NKF
Albuminuria is the preferred measure for definition and staging of chronic kidney disease (CKD), but total urine protein or dipstick protein is often measured instead. To develop equations for the conversion of urine protein-to-creatinine ratio (PCR) and dipstick protein to urine albumin-to-creatinine ratio (ACR) and test their diagnostic accuracy in CKD screening and staging. Individual participant-based meta-analysis. 12 research cohorts and 21 clinical cohorts. 919,383 adults with same-day measures of ACR and PCR or dipstick protein. 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 (A2: ACR 30-299 mg/g; A3: ≥300 mg/g). Median ACR was 14 mg/g (25th to 75th percentile of cohorts 5-25). The association between PCR and ACR was inconsistent for values of PCR <50 mg/g. For higher values of PCR, the PCR conversion equations demonstrated moderate sensitivity (91%; 75%; 87%) and specificity (87%; 89%; 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace/+, and ++ for screening for ACR >30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%; 36%; 78%) and high specificity (88%; 88%; 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had similar discrimination compared to that using observed ACR. Diverse methods of ACR and PCR quantification; not necessarily the same urine sample. Urine ACR is the preferred measure of albuminuria; however, when ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis. NIDDK and NKF