• James Fotheringham, Michael J Campbell, Damian G Fogarty, Meguid El Nahas, and Timothy Ellam.
• Sheffield Kidney Institute, Sheffield, United Kingdom; School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
• Am. J. Kidney Dis. 2014 Mar 1; 63 (3): 405-14.

BackgroundGlomerular filtration rate estimation equations use demographic variables to account for predicted differences in creatinine generation rate. In contrast, assessment of albuminuria from urine albumin-creatinine ratio (ACR) does not account for these demographic variables, potentially distorting albuminuria prevalence estimates and clinical decision making.Study DesignPolynomial regression was used to derive an age-, sex-, and race-based equation for estimation of urine creatinine excretion rate, suitable for use in automated estimated albumin excretion rate (eAER) reporting.Setting & ParticipantsThe MDRD (Modification of Diet in Renal Disease) Study cohort (N=1,693) was used for equation derivation. Validation populations were the CRIC (Chronic Renal Insufficiency Cohort; N=3,645) and the DCCT (Diabetes Control and Complications Trial; N=1,179).Index TesteAER, calculated by multiplying ACR by estimated creatinine excretion rate, and ACR.Reference TestMeasured albumin excretion rate (mAER) from timed 24-hour urine collection.ResultseAER estimated mAER more accurately than ACR; the percentages of CRIC participants with eAER within 15% and 30% of mAER were 33% and 60%, respectively, versus 24% and 39% for ACR. Equivalent proportions in DCCT were 52% and 86% versus 15% and 38%. The median bias of ACR was -20.1% and -37.5% in CRIC and DCCT, respectively, whereas that of eAER was +3.8% and -9.7%. Performance of eAER also was more consistent across age and sex categories than ACR.LimitationsSingle timed urine specimens used for mAER, ACR, and eAER.ConclusionsAutomated eAER reporting potentially is a useful approach to improve the accuracy and consistency of clinical albuminuria assessment.Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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