Albumin: Creatinine Ratio (ACR) in Diabetic Nephropathy Detection, Phitsanulok

PROBLEM/BACKGROUND: Albumin-to-creatinine ratio (ACR) is used for diabetic nephropathy screening in diabetic patients and reno-cardiovascular risk detection in high risk patients. Many guidelines have different ranges in abnormality diagnosis of ACR. OBJECTIVE: To compare the reference ranges from many guidelines of ACR abnormality detection for subsidize with 24- hour urine albumin excretion (UAE) in diabetic nephropathy screening. RESEARCH DESIGN: A retrospective analytic study. SETTING: Buddhachinaraj Phitsanulok Hospital MATERIALS and METHOD: Three groups of data (all ACR, all UAE, ACR and UAE in the same time) were collected for albumin, ACR, creatinine and urine volume. Compare UAE with various ranges of ACR from many guidelines. Statistical analysis was done using median, quartile, sensitivity, specificity, positive and negative predictive value, chi-square test, Mann-Whitney U test and kappa value with significant level at 0.05. RESULTS: 1,194 UAE had albumin, creatinine, urine volume analysis. Median values of creatinine in male was higher than female ( 1.2 gm, 0.8 gm). Median values of albumin in male was higher than female ( 17.35 mg, 10.55 mg), but ACR in male was lower than female ( 15.6 mg/gm, 18.9 mg/gm). There was no difference between reference ranges of ACR from many guidelines with UAE in urinary albumin excretion abnormality detection. Sensitivity was about 0.50-0.65 , specificity was 0.80-0.89 and kappa values was 0.408-0.468 CONCLUSION: ACR is suboptimal in diabetic nephropathy screening and may result in delayed diagnosis and treatment.