Quantifying Protein loss in patients living with diabetes mellitus (PLWD) in resource-limited settings: Urine ACR or PCR?

Abstract

Background: Nephropathy is a common morbidity associated with diabetes mellitus (DM). Proteinuria indicates renal injury which increases patients’ cardiovascular risk. Presently, the recommended method for detecting proteinuria is the urine albumin-creatinine-ratio (ACR); however, this test is more exorbitant than both the urine dipstick and the protein-creatinine-ratio (PCR). Objective: To describe the extend of proteinuria in PLWD and determine the best method of detecting it. Method: A prospective study was performed using patients attending the diabetes clinic at Edendale Hospital between December 2017 and February 2018. Urine protein was analyzed using regression analysis. Results: A total of 156 patients were used for analysis. Urine dipstick detected only 30 (19.23%) patients with proteinuria. The urine ACR and PCR detected 73 (46.79%) and 95 (60.9%) patients with proteinuria, respectively (p=0.09). Of these 73 and 95 patients, only 22 and 24 patients had proteinuria detected on dipstick, respectively. The positive predictive value of urine dipsticks in detecting proteinuria compared to urine ACR and PCR was 30.1% and 25.3%, respectively. The urine PCR and ACR values showed good correlation (p