Use of albumin XXXX ratio and urine albumin concentration as a screening test for @entity633 in an Indo-Asian population.

@entity1 @entity740 @entity633 @entity1011 @entity65
BACKGROUND: @entity633 (>30 mg/day) based on 24 h urine albumin excretion is one of the criteria for @entity740 ( @entity740 ) and a predictor of @entity65 ( @entity65 ). Differences in urine albumin concentration and @entity1011 excretion rates between Indo-Asians and other populations may require different threshold values for detection of @entity633 . We compared the use of spot urine albumin concentration and urine albumin to @entity1011 excretion ratio for detection of @entity633 in this population. METHODS: A total of 577 subjects aged >or=40 years, 54% of whom were @entity1 , were recruited from the general population in Karachi, Pakistan. Albumin concentration (mg/l) and albumin to @entity1011 ratio (mg/g of @entity1011 ) were determined in a spot morning urine sample, and @entity633 (30 mg/day or greater) measured in a 24 h urine collected on the subsequent day. RESULTS: The median (25-75 percentile) of urine albumin excretion was 4.8 (3.6-10.3) mg/day: 5.4 (3.7-12.5) mg/day in @entity1 and 4.5 (3.8-8.9) mg/day in @entity1 . The overall prevalence (95% CI) of @entity633 was 11.8% (7.2-12.0%): 14.8% in @entity1 and 9.2% in @entity1 (P = 0.04). The areas under the receiver operator characteristic (ROC) curves for urine albumin concentration were 0.86 (0.82-0.90) and 0.88 (0.84-0.92), respectively, in @entity1 and @entity1 . The areas under the ROC curves for albumin to @entity1011 ratio were 0.86 (0.82-0.89) and 0.90 (0.86-0.93), respectively, in @entity1 and @entity1 . For urine albumin concentration, the sensitivity and specificity were 37 and 97%, respectively, in @entity1 and 69 and 94%, respectively, in @entity1 at the conventionally recommended value of 2 mg/dl. The discriminator value of urine albumin concentration identified in the analysis was 0.5 mg/dl in @entity1 (sensitivity of 87% and specificity of 75%) and 1.7 mg/dl in @entity1 (sensitivity of 74% and specificity of 93%). For the albumin to @entity1011 ratio, the sensitivity and specificity were 46 and 95%, respectively, in @entity1 and 60 and 97%, respectively, in @entity1 at cut-off value of 30 mg/g. CONCLUSION: Both urine albumin concentration and albumin to @entity1011 ratio are acceptable tests for population screening for @entity633 in Indo-Asians. While sensitivities may be suboptimal, particularly in @entity1 , lowering the existing thresholds would compromise specificity. Those who screen positive need evaluation and management of @entity740 and prevention of @entity65 .
