估算的白蛋白排泄率与尿白蛋白/肌酐比值用于评估白蛋白尿：来自预防肾脏和血管终末期疾病（PREVEND）研究的诊断测试研究。
Estimated albumin excretion rate versus urine albumin-creatinine ratio for the assessment of albuminuria: a diagnostic test study from the Prevention of Renal and Vascular Endstage Disease (PREVEND) Study.
机构信息
Division of Nephrology, Department of Medicine, University of California, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
出版信息
Am J Kidney Dis. 2014 Mar;63(3):415-21. doi: 10.1053/j.ajkd.2013.10.061. Epub 2013 Dec 21.
BACKGROUND
Albumin-creatinine ratio (ACR) in spot urine samples is recommended for albuminuria screening instead of measured albumin excretion rate (mAER) in 24-hour urine collections. In patients with extremes of muscle mass, differences in spot urine creatinine values may lead to under- or overestimation of mAER by ACR. We hypothesized that calculating estimated AER (eAER) using spot ACR and estimated creatinine excretion rate (eCER) may improve albuminuria assessment.
STUDY DESIGN
Diagnostic test study.
SETTING & PARTICIPANTS: 2,711 community-living individuals from the general population of the Netherlands participating in the PREVEND (Prevention of Renal and Vascular Endstage Disease) Study.
INDEX TEST
eAER was computed as the product of ACR and eCER. eCER was computed using 3 previously validated methods (Ix, Ellam, and Walser).
REFERENCE TEST
mAER, based on two 24-hour urine collections. Accuracy of the eAER and ACR were defined as the percentage of participants falling within 30% (P30) of mAER.
RESULTS
Mean age was 49 years, 46% were men, mean estimated glomerular filtration rate was 84 ± 15 mL/min/1.73 m(2), and median mAER was 7.2 (IQR, 5.4-11.0) mg/d. Mean measured CER was 1,381 mg/d, and median ACR was 4.9 mg/g. Using the Ix equation, median eAER was 6.4 mg/d. In the full cohort, eAER was more accurate and less biased compared to ACR (P30, 48.9% vs 33.6%; bias, -34.2% vs -14.1%, respectively). In subgroup analysis, improvement was most notable in the middle and highest weight tertiles and in men. Using the other methods for eCER produced similar results.
LIMITATIONS
Little ethnic heterogeneity and a generally healthy cohort make extension of findings to other races and the chronically ill uncertain.
CONCLUSIONS
In a large community-dwelling cohort, eAER was more accurate than ACR in assessing albuminuria.
背景
相比于 24 小时尿液收集测量的白蛋白排泄率（mAER），点尿白蛋白与肌酐比值（ACR）更适用于筛查白蛋白尿。在肌肉量存在极值的患者中，点尿肌酐值的差异可能导致 ACR 对 mAER 的低估或高估。我们假设，使用点 ACR 和估计肌酐排泄率（eCER）计算估计的 AER（eAER）可能会改善白蛋白尿的评估。
研究设计
诊断测试研究。
研究场所与参与者
2711 名来自荷兰普通人群的社区居住者参加了 PREVEND（预防肾脏和血管终末期疾病）研究。
检测指标
eAER 是 ACR 与 eCER 的乘积。eCER 使用 3 种先前验证的方法（Ix、Ellam 和 Walser）计算。
参考指标
基于两次 24 小时尿液收集的 mAER。eAER 和 ACR 的准确性定义为与 mAER 相差 30%（P30）以内的参与者百分比。
结果
平均年龄为 49 岁，46%为男性，平均估计肾小球滤过率为 84±15 mL/min/1.73 m2，中位数 mAER 为 7.2（IQR，5.4-11.0）mg/d。平均实测 CER 为 1381 mg/d，中位数 ACR 为 4.9 mg/g。使用 Ix 方程，中位数 eAER 为 6.4 mg/d。在整个队列中，eAER 比 ACR 更准确且偏差更小（P30，分别为 48.9%和 33.6%；偏差，分别为-34.2%和-14.1%）。在亚组分析中，在中间和最高体重三分位组和男性中，改善最为显著。使用其他方法计算 eCER 也得到了相似的结果。
局限性
种族异质性小，队列整体健康，使研究结果在其他种族和慢性病患者中推广的不确定性增加。
结论
在一个大型社区居住者队列中，eAER 在评估白蛋白尿方面比 ACR 更准确。
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