Assessment of urinary albumin-creatinine ratio in the diabetic patient : a retrospective study

Abstract

BACKGROUND: Microalbuminuria is one of the earliest markers of diabetic kidney disease. Hence, the National Institute for Health and Care Excellence (NICE, NG18) recommends screening diabetic adults, children and young people on an annual basis with urinary albumin-to-creatinine ratio (ACR) for the early detection of diabetic kidney disease. Timely detection of a positive urinary ACR leads to earlier intervention, better glycaemic control and surveillance.

METHOD: Patients over the age of 18 attending the Diabetes Clinic at Mater Dei Hospital over a 1-week period in June 2021 were identified. Data regarding order requests and test results of urinary ACR was collected from iSOFT Clinical Manager System and iLab Laboratory Information System in liaison with the Clinical Chemistry Lab.

RESULTS: A total of 168 patients were identified for the purpose of this study. The majority (45.2%) had a new case appointment and were excluded. Results show that despite urinary ACR being requested by the reviewing physician (90.2%), only 49.4% of these test samples were submitted to the laboratory services. The median average urinary ACR was found to be 13.9mg/g.

CONCLUSION: There is appropriate knowledge amongst doctors caring for diabetic patients regarding the importance of checking urinary ACR yearly. Suboptimal sample submission rate highlights the lack of awareness amongst patients about its underlying use of detecting kidney disease. Hence, improved patient education and logistical planning are required to ensure detection and timely intervention.