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Background: Chronic kidney disease (CKD) needs to be detected early in order to prevent a poor outcome in the general population. A semiquantitative evaluation based on a dipstick has become available to detect the urinary albumin-tocreatinine ratio (ACR) and proteinuria simultaneously in spot urine samples. The aim of this study was to compare dipstick ACR with proteinuria for CKD screening in a primary healthcare setting. Methods: This cross-sectional study analyzed 88,479 subjects who underwent a health check up at 16 health promotion centers in 13 Korean cities. Dipstick ACR and proteinuria was measured using the automated urine test strip analyzer UC3500 (Sysmex, Kobe, Japan). CKD definition and risk categories according to the 2012 Kidney Disease: Improving Global Outcomes guidelines were created using a combination of eGFR and albuminuria. Albuminuria was defined using dipstick ACR ≥ 30 mg/g and dipstick proteinuria as ≥ trace or protein-to-creatinine ratio (PCR) ≥ 150 mg/g. Results: The prevalence of CKD using dipstick ACR, proteinuria, and PCR were 16.3%, 12.7%, and 11.9%, respectively. The concordance rates between the dipstick ACRand proteinuriaor PCR-based CKD risk categories were 88.76% (κ = 0.567) and 92.06% (κ = 0.683), respectively. On being grouped according to dipstick proteinuria, CKD risk categories would be underestimated than be overestimated. 37.2% and 37.6% of the subjects with ≥ moderately increased CKD risk using ACR-based category were reclassified into lower risk CKD using dipstick proteinuria (≥ trace) and PCR, respectively. Conclusion: The CKD risk category using dipstick proteinuria was underestimated compared to the ACR-based CKD risk category. These data suggest that screening of CKD using dipstick ACR is recommended in primary healthcare settings.

Screening of Chronic Kidney Disease in Primary Health: Comparison of the Urine Dipstick Albumin-to-Creatinine Ratio and Dipstick Proteinuria