The clinical applicability of albuminuria testing in Japanese hypertensive patients: the AVA-E study.

OBJECTIVE Albuminuria is thought to reflect generalized endothelial dysfunction. In hypertensive patients, albuminuria increases the risk of cardiovascular disease (CVD) events. Therefore, screening for albuminuria is critical for stratifying risks in hypertensive patients. However, a limited number of Japanese studies have performed quantitative examinations of albuminuria. The objective of this study was to examine the utility of the CLINITEK MICROALB CREATININE TEST for albuminuria screening. MATERIALS The CLINITEK MICROALB CREATININE TEST consists of a urine test strip that assesses albumin excretion corrected for the urine creatinine levels in only 60 seconds without the need for any special facilities. The CLINITEK MICROALB CREATININE TEST was performed in 5,647 Japanese hypertensive patients, excluding diabetic patients, and the clinical significance of the test was evaluated. RESULTS According to the CLINITEK MICROALB CREATININE TEST, the A1 (albumin creatinine ratio: ACR <30 mg/g･creatinine), A2 (ACR 30-299 mg/g･creatinine) and A3 (ACR ≥ 300 mg/g･creatinine) levels of albuminuria were present in 61.2%, 32.5% and 6.3% of the patients surveyed, respectively. The proportions of A2 and A3 patients increased with chronic kidney disease (CKD) stage, blood pressure, age and previous history of CVD. According to a multivariate logistic regression analysis, the A2 and A3 levels of albuminuria were found to be independently associated with a previous history of CVD (odds ratio: 1.36, 95% confidence interval: 1.08-1.72, p<0.01) after adjusting for age, diabetes, blood pressure and estimated glomerular filtration rate (eGFR). CONCLUSION In hypertensive patients, the A2 and A3 levels of albuminuria on the CLINITEK MICROALB CREATININE TEST are associated with a previous history of CVD, independent of eGFR. Therefore, by reflecting the status of systemic vascular injury, this test may help to perform CVD risk stratification.