Diagnostic accuracy of UACR in CKD screening among diabetics: A community study.

Chronic kidney disease (CKD) is a major microvascular complication of diabetes in rural India, where access to diagnostic facilities is limited. 24-hour urine protein estimation, through the reference method is impractical for community screening. Therefore, it is of interest to evaluate the diagnostic accuracy of urinary albumin-to-creatinine ratio (UACR) for CKD screening among 201 known diabetic individuals from rural Nagpur. Elevated UACR was observed in 99% of participants, whereas 59% had abnormal 24-hour urine protein excretion. UACR demonstrated 100% sensitivity but low specificity (4%), with an overall diagnostic accuracy of 60% and a negative predictive value of 100%. UACR correlated significantly with glycaemic indices, eGFR and proteinuria and its screening utility improves when combined with serum creatinine and eGFR in resource-limited community settings.