Three investigations (21,22,26) examined the performance measures of UACR in predicting microalbuminuria ��30 mg/d in diabetics and in the selleck catalog general population and confirmed that lower gender-specific cutoffs should be used. Considering the 30-mg/g threshold for UACR as equivalent to a 30-mg/d UAER ignores the fact that the daily urine creatinine excretion rate in an ��average�� adult is >1 g/d (27,28) and neglects the gender-related difference in creatinine excretion. The expected consequence of using this uniform cutoff is a decreased sensitivity of the test for a subject with an average or ��above average�� urinary creatinine excretion rate and a decreased specificity for subjects with low urinary creatinine excretion due to a low muscular mass.

Performance Measures of UACR for the Detection of Albuminuria ��30 mg/d The ROC analysis confirms that UACR is an excellent test for the diagnosis of microalbuminuria in both genders, with an area under the curve of 0.94 to 0.98, which reflects the relatively low loss in specificity traded off for an increase in sensitivity. This study confirms that using a cutoff of 30 mg/g for UACR to detect microalbuminuria provides relatively low sensitivity, which would result in missing the diagnosis in 21% of the cases in men and in 10% of the cases in women. Using the gender-specific cutoffs of 17 for men and 25 for women previously proposed by some guidelines (14,17,18) increases the sensitivity by 10% and 7% in men and women, respectively. In this case, diagnosis would be missed in 11% of men and 3% of women.

The performance of these cutoffs (17 and 25 mg/g in men and women) is close to that of the optimal cutoffs defined in the study presented here (21 mg/g in men and 24 mg/g in women). The tradeoff of abandoning the use of the 30-mg/g traditional cutoff would be a decreased specificity, resulting in more subjects, especially men, being misdiagnosed as having microalbuminuria. The consequent decreased specificity may result in overtreating patients, which is unwanted, or in the need to perform another test to confirm or exclude the diagnosis of microalbuminuria. Because the confirmatory test (a 24-hour urine collection) is cheap and devoid of side effects, except for being cumbersome, it is worthwhile using the lower gender-associated cutoffs rather than the 30-mg/g cutoff to obtain a high sensitivity. The renal transplant population Dacomitinib had advanced chronic kidney disease for years before kidney transplantation. Advanced chronic kidney disease may be associated with a decrease in lean body mass leading to a low creatinine excretion rate. This may lead to a decreased performance of the UACR test if the same cutoffs as those used for the general population are used (29).