Daily Dose: Majority of US Adults with HTN or T2D with Albuminuria go Undetected

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 31, 2023, we reported on a study published in JAMA Network Open that aimed to estimate the extent of albuminuria underdetection in US clinical health systems and then to evaluate whether urine albumin-creatinine ratio (UACR) testing was associated with odds of receiving evidence-based therapy to reduce risk of chronic kidney disease (CKD) progression or complications in patients with hypertension (HTN) or type 2 diabetes (T2D).

The study

Researchers used data from National Health and Nutrition Examination Surveys (NHANES) (2007 to 2018) and the Optum deidentified electronic health record (EHR) data set for adults with T2D or HTN. After developing a logistic regression model to estimate albuminuria (UACR ≥30 mg/g) for the cohort, they applied the model to active outpatients in the Optum EHR from January 1, 2017, to December 31, 2018.

The primary outcome of interest was the estimated total prevalence of albuminuria among those who had and who had not been tested within the EHR cohort.

Investigators then turned to an examination of associations between having albuminuria testing and use of CKD therapies in the participants with at least 12 months of follow-up after the index date. Using multivariable logistic regression, they evaluated associations between UACR testing and ACE inhibitor or ARB treatment, sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment, and blood pressure control meeting the CKD guideline-recommended level of <130/80 mm Hg or slightly higher, at <140/90 mm Hg, on the latest outpatient measure.

The findings

There were 192 108 individuals included from the Optum EHR database who had a mean age of 60 years. Of them, 96.6% (185 589) had HTN, 26.2% (50 507) had T2D, and the mean eGFR was 84 mL/min/1.73m².

Among the cohort, 17.5% (33 629) underwent UACR testing, with confirmed albuminuria reported in 34.3% (11 525). UACR testing, the team pointed out was significantly more common among participants with T2D only (52.3%) than those with only hypertension (5.1%).

Researchers calculated the true prevalence of albuminuria among participants who were tested to be 34% and estimated the prevalence as 13.4% of participants who were not tested. Based on these data, the researchers estimated that just slightly more than one-third (35.2%) of the projected population with albuminuria had been tested for the marker.

Authors' commentary

“Early identification of albuminuria is increasingly crucial given the growing number of therapies, such as [SGLT2 inhibitors] and nonsteroidal mineralocorticoid antagonists that have been shown to slow the progression of CKD and prevent cardiovascular complications. More albuminuria testing is clearly needed among at-risk persons to ensure effective dissemination of these therapies and to fully realize their potential benefit.”

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