To screen at-risk patients for albuminuria, quantitative tests can be used effectively at the point of care (POC), but semiquantitative tests are not sufficiently accurate, a recent meta-analysis found.
Researchers included 16 studies with more than 3,000 patients that compared semiquantitative or quantitative machine-read POC tests of urinary albumin-creatinine ratio to laboratory measurements. Results were published in the April 15 Annals of Internal Medicine.
According to a bivariate random-effects model, the semiquantitative tests had a sensitivity of 76% (95% CI, 63% to 86%) and a specificity of 93% (CI, 84% to 97%), while the quantitative tests had a sensitivity of 96% (CI, 78% to 99%) and a specificity of 98% (CI, 93% to 99%). The negative likelihood ratios were 0.26 (CI, 0.16 to 0.40) for semiquantitative tests and 0.04 (CI, 0.01 to 0.25) for quantitative.
The American Diabetes Association and the American Association for Clinical Chemistry have suggested that such screening tests should have sensitivity exceeding 95%, the study authors noted. Thus, based on the results, only the quantitative tests, not the semiquantitative tests, should be used to rule out albuminuria. Sensitivity is more important than specificity in albuminuria testing, because a diagnosis requires 2 out of 3 samples collected during a 6-month period to be positive.
The ability to get a rapid result from POC testing is useful because patients with negative results can be sent on their way and those with positive results can be told immediately about the need for further testing. There may also be potential cost savings in transport and laboratory testing, the study authors said.
Annals of Internal Medicine's Diabetes Collection is available online.