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Song JJ, Lee KB, Hyun YY, Kim H: Trace Albumin in the Urine Dipstick Test is Associated with Coronary Artery Calcification in Korean Adults. Nephron 10.1159/000490954
Albuminuria, even in the high normal range (> 10 and < 30 mg/d), is associated with the presence or development of cardiovascular disease (CVD), including atherosclerotic CVD. Whether this association is directly causal or reverse causal is not known. Coronary artery calcification (CAC) is believed to be a useful non-traditional predictor of CVD, although this is debated [1].
Song and co-workers conducted an observational, cross-sectional study of 46,002 Korean adults, all without known prior CVD, in whom both CAC scoring and urine dipstick for albuminuria were performed (the latter only once; randomly). Three groups were analyzed: group I – negative for albuminuria; group II – trace for albuminuria; group III – positive (1 – 4+) for albuminuria. An abnormal CAC score was defined as > 100 units.
The % with an abnormal CAC score were 2.0 % in group I, 2.8 % in Group II and 4.9 % in group III. The odds ratios for an abnormal CAC score were 1.72 (CI = 1.10 – 2.41) for group III and 1.34 (CI = 1.07 – 1.64) for group II using group I as the reference, in a “fully adjusted” model. The association of low-grade albuminuria with elevated CAC scores could be due to common risk factors, or due to low-grade underlying inflammation and endothelial dysfunction. Whether the use of trace albuminuria by dipstick will be a useful simple screening test for the presence of underlying CAC is unknown. The use of a single urine test in this study is a weakness as it is well known that single urine testing for albuminuria has a high false-positive rate.
References
1. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB: Risk Assessment for Cardiovascular Disease with Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA 2018; 320:272-280
