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Lee, Kwon, Oh, Lee, Chang, Cha, Son, and Sohn: Association of Spot Urine Albumin-to-Creatinine Ratio and 24 Hour-Collected Urine Albumin Excretion Rate in Patients with Type 2 Diabetes Mellitus
Original Article
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(4): 299-305.

Published online: 31 August 2009

DOI: https://doi.org/10.4093/kdj.2009.33.4.299

Association of Spot Urine Albumin-to-Creatinine Ratio and 24 Hour-Collected Urine Albumin Excretion Rate in Patients with Type 2 Diabetes Mellitus

Jee In Lee, Hyuk Sang Kwon, Su Jin Oh, Jung Min Lee, Sang Ah Chang, Bong Yun Cha, Hyun Shik Son, Tae Seo Sohn

Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding author (imsts@catholic.ac.kr)

Received 24 April 2009       Accepted 6 July 2009

Copyright © 2009 Korean Diabetes Association

Abstract

Background

Measuring urine albumin in diabetic patients is an important screening test to identify those individuals at high risk for cardiovascular disease and the progression of kidney disease. Recently, spot urine albumin-to-creatinine ratio (ACR) has replaced 24 hour-collected urine albumin excretion rate (AER) as a screening test for microalbuminuria given its comparative simplicity. The purpose of the current study was to evaluate the degree of correlation between AER and ACR in the normal, microalbuminuric and macroalbuminuric ranges, and to identify the lower limits of ACR for both genders.

Methods

A total of 310 type 2 diabetics admitted to one center were enrolled in the present study. Following the collection of a spot urine sample, urine was collected for 24 hours and albumin content was measured in both specimens.

Results

Mean patient age was 60.2 years. A total of 25.4% had microalbuminuria and 15.8% had macroalbuminuria. The data revealed a strongly positive correlation between AER and ACR across all ranges of albuminuria (R = 0.8). The cut-off value of ACR for 30 mg/day of AER by the regression equation was 24 µg/mg for men, 42 µg/mg for women and 31.2 µg/mg for all patients. The diagnostic performance expressed as the area under the curve (AUC) was 0.938 (95% CI, 0.911-0.965) for ACR. ACR revealed a sensitivity of 84% and specificity of 84%, when a cut-off value of 31.2 µg/mg was employed.

Conclusion

ACR was highly correlated with AER, particularly in the range of microalbuminuria. The gender combined cut-off value of ACR in type 2 diabetic patients was determined to be 31.2 µg/mg However, additional studies of large outpatient populations, as opposed to the inpatient population used in the present study, are required to confirm the utility of this value.

Keywords: Albuminuria, Diabetic nephropathies, Type 2 diabetes mellitus

Figures and Tables

Fig. 1
Relationship between albumin excretion rate (AER) and albumin-to-creatinine ratio (ACR).
kdj-33-299-g001
Fig. 2
Correlation between albumin excretion rate (AER) and albumin to-creatinine ratio (ACR) in male and female.
kdj-33-299-g002
Fig. 3
Receiver operating characteristics curve for albumin-to-creatinine ratio in diagnosis microalbuminuria: Area under the curve = 0.938.
kdj-33-299-g003
Table 1
Baseline characteristics of the patients
kdj-33-299-i001

Data are expressed as means ± S.D or n (%). BMI, body mass index; DM, diabetes mellitus; No., number; ns, non-significant.

Table 2
Comparison of clinical characteristics according to the ranges of albuminuria
kdj-33-299-i002

Data are expressed as means ± S.D. *abcValues with different alphabets are significantly different among the three groups by Ducan's multiple range test: P < 0.05. BMI, body mass index; Cr, creatinine; DBP, diastolic blood pressure; DM, diabetes mellitus; ns, non-significant; SBP, systolic blood pressure; WC, Waist circumference.

Table 3
Characteristics of spot ACR as a screening test for microalbuminuria by gender
kdj-33-299-i003

ACR, albumin-creatinine ratio; NPV, negative predictive value; PPV, positive predictive value.

Table 4
Sensitivity and specificity of the spot ACR at cut-off values from Receiver operating characteristics curve
kdj-33-299-i004

ACR, albumin-creatinine ratio.

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