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Spot urine estimations are equivalent to 24-hour urine assessments of urine protein excretion for predicting clinical outcomes.

Teo BW, Loh PT, Wong WK, Ho PJ, Choi KP, Toh QC, Xu H, Saw S, Lau T, Sethi S, Lee EJ - Int J Nephrol (2015)

Bottom Line: Results.Conclusions.We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore 119228.

ABSTRACT
Background. The use of spot urine protein to creatinine ratios in estimating 24 hr urine protein excretion rates for diagnosing and managing chronic kidney disease (CKD) predated the standardization of creatinine assays. The comparative predictive performance of spot urine ratios and 24 hr urine collections (of albumin or protein) for the clinical outcomes of CKD progression, end-stage renal disease (ESRD), and mortality in Asians is unclear. We compared 4 methods of assessing urine protein excretion in a multiethnic population of CKD patients. Methods. Patients with CKD (n = 232) provided 24 hr urine collections followed by spot urine samples the next morning. We created multiple linear regression models to assess the factors associated with GFR decline (median follow-up: 37 months, IQR 26-41) and constructed Cox proportional-hazards models for predicting the combined outcome of ESRD and death. Results. The linear regression models showed that 24 hr urine protein excretion was most predictive of GFR decline but all other methods were similar. For the combined outcomes of ESRD and death, the proportional hazards models had similar predictive performance. Conclusions. We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research.

No MeSH data available.


Related in: MedlinePlus

Distribution of urine estimation ratios to 24 hr urine measurements. (a-1) UPCR versus 24 hr urine protein excretion. Correlation r = 0.79, 95% CI 0.74–0.83. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (a-2) Limits of agreement of Log-transformed UPCR and 24 hr urine protein excretion. (b-1) UACR versus 24 hr urine albumin excretion. Correlation r = 0.86, 95% CI 0.82–0.89. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (b-2) Limits of agreement of Log-transformed UACR and 24 hr urine albumin excretion.
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fig1: Distribution of urine estimation ratios to 24 hr urine measurements. (a-1) UPCR versus 24 hr urine protein excretion. Correlation r = 0.79, 95% CI 0.74–0.83. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (a-2) Limits of agreement of Log-transformed UPCR and 24 hr urine protein excretion. (b-1) UACR versus 24 hr urine albumin excretion. Correlation r = 0.86, 95% CI 0.82–0.89. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (b-2) Limits of agreement of Log-transformed UACR and 24 hr urine albumin excretion.

Mentions: There were 232 patients with characteristics as shown in Table 1. Four patients had 24-hour urine protein excretion >3.5 g. The correlation of spot urine estimation ratios (UPCR and UACR to 24 hr urine protein and albumin excretion, resp.) is shown in Figure 1. UACR appears to predict 24 hr urine albumin excretion better as the slope is closer to 1. The prediction equations are(1)Log  24 hr  urine  protein  excretiong  =−0.617019+0.7150918×Log  UPCRmg/mg;hhhhhhhhhhhhhhhhhhhhhhhhR2=0.64,P<0.001,Log  24 hr  urine  albumin  excretiong  =−0.800153+0.8257142×Log  UACRmg/mg;hhhhhhhhhhhhhhhhhhhhhhhh(R2=0.74,P<0.001).


Spot urine estimations are equivalent to 24-hour urine assessments of urine protein excretion for predicting clinical outcomes.

Teo BW, Loh PT, Wong WK, Ho PJ, Choi KP, Toh QC, Xu H, Saw S, Lau T, Sethi S, Lee EJ - Int J Nephrol (2015)

Distribution of urine estimation ratios to 24 hr urine measurements. (a-1) UPCR versus 24 hr urine protein excretion. Correlation r = 0.79, 95% CI 0.74–0.83. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (a-2) Limits of agreement of Log-transformed UPCR and 24 hr urine protein excretion. (b-1) UACR versus 24 hr urine albumin excretion. Correlation r = 0.86, 95% CI 0.82–0.89. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (b-2) Limits of agreement of Log-transformed UACR and 24 hr urine albumin excretion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4306405&req=5

fig1: Distribution of urine estimation ratios to 24 hr urine measurements. (a-1) UPCR versus 24 hr urine protein excretion. Correlation r = 0.79, 95% CI 0.74–0.83. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (a-2) Limits of agreement of Log-transformed UPCR and 24 hr urine protein excretion. (b-1) UACR versus 24 hr urine albumin excretion. Correlation r = 0.86, 95% CI 0.82–0.89. Bold line: line of identity; fine line: regression line; dotted lines: 95% CI of the regression line. (b-2) Limits of agreement of Log-transformed UACR and 24 hr urine albumin excretion.
Mentions: There were 232 patients with characteristics as shown in Table 1. Four patients had 24-hour urine protein excretion >3.5 g. The correlation of spot urine estimation ratios (UPCR and UACR to 24 hr urine protein and albumin excretion, resp.) is shown in Figure 1. UACR appears to predict 24 hr urine albumin excretion better as the slope is closer to 1. The prediction equations are(1)Log  24 hr  urine  protein  excretiong  =−0.617019+0.7150918×Log  UPCRmg/mg;hhhhhhhhhhhhhhhhhhhhhhhhR2=0.64,P<0.001,Log  24 hr  urine  albumin  excretiong  =−0.800153+0.8257142×Log  UACRmg/mg;hhhhhhhhhhhhhhhhhhhhhhhh(R2=0.74,P<0.001).

Bottom Line: Results.Conclusions.We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore 119228.

ABSTRACT
Background. The use of spot urine protein to creatinine ratios in estimating 24 hr urine protein excretion rates for diagnosing and managing chronic kidney disease (CKD) predated the standardization of creatinine assays. The comparative predictive performance of spot urine ratios and 24 hr urine collections (of albumin or protein) for the clinical outcomes of CKD progression, end-stage renal disease (ESRD), and mortality in Asians is unclear. We compared 4 methods of assessing urine protein excretion in a multiethnic population of CKD patients. Methods. Patients with CKD (n = 232) provided 24 hr urine collections followed by spot urine samples the next morning. We created multiple linear regression models to assess the factors associated with GFR decline (median follow-up: 37 months, IQR 26-41) and constructed Cox proportional-hazards models for predicting the combined outcome of ESRD and death. Results. The linear regression models showed that 24 hr urine protein excretion was most predictive of GFR decline but all other methods were similar. For the combined outcomes of ESRD and death, the proportional hazards models had similar predictive performance. Conclusions. We showed that all methods of assessments were comparable for clinical end-points, and any method can be used in clinical practice or research.

No MeSH data available.


Related in: MedlinePlus