High Prevalence and Low Awareness of Albuminuria in the Community Setting in the KDSAP

Abstract

Introduction: Albuminuria is a sign of kidney disease and associated with adverse outcomes. However, most individuals with albuminuria are unaware of it. The Kidney Disease Screening and Awareness Program (KDSAP) aims for early detection and raising awareness of albuminuria, targeting underserved populations in communities. This study will assess the prevalence and awareness of albuminuria and identify associated risk factors among KDSAP participants.

Methods: KDSAP participants ≥18 years old without a history of dialysis or kidney transplant were included. Albuminuria was identified by dipstick urinalysis. Individuals with albuminuria who answered yes to either of the following 2 questions were defined as being aware: (i) Have you ever had protein in the urine? (ii) Do you have kidney disease?

Results: Among 2304 participants, 461 (20.0%) had albuminuria: 16.3% with trace or 1+ (low degree) and 3.7% with 2+ or more (high degree). Correlating factors of albuminuria included young age, male sex, African American descent, self-reported diabetes, hypertension, family history of kidney disease, and smoking. Overall albuminuria awareness was 15.8%, but awareness inversely correlated to younger age groups: 7.0% for ages 18-39 years, 13.5% for ages 40-59 years, and 24.0% for ages ≥60 years (P < 0.001). A high degree of albuminuria (vs. low, odds ratio: 5.04, P < 0.001) and concurrent hematuria (odds ratio: 2.12, P=0.024) were both associated with higher awareness; conversely, risk factors for low awareness included African American and better self-assessments of health.

Conclusions: There was a high albuminuria prevalence among KDSAP participants, yet low awareness. KDSAP can potentially be a useful model for detecting albuminuria and raising awareness in communities.

Keywords: Kidney Disease Screening and Awareness Program (KDSAP); albuminuria; awareness; chronic kidney disease (CKD); community screening; proteinuria.

Graphical abstract

Figure 1

High prevalence of albuminuria among Kidney Disease Screening and Awareness Program (KDSAP) population and particularly in the youngest age group. (a) Among 2304 participants, 461 (20.0%) were found to have albuminuria: 219 (9.5%) with trace, 156 (6.8%) with 1+, 67 (2.9%) with 2+, and 19 (0.8%) with 3+. (b) The prevalence of albuminuria was highest in the youngest age group: 24.7% in 18–39 years old, 18.3% in 40–59 years old, and 19.1% in ≥60 years old, P = 0.01.

Figure 2

Higher blood pressure, body mass index (BMI), and proportion of hematuria were detected among the albuminuric group during the screenings. Results collected during the screenings showed that (a) mean systolic blood pressure (SBP; 135.2 ± 21.1 vs. 130.0 ± 17.8, P < 0.001), diastolic blood pressure (DBP; 82.1 ± 13.6 vs. 78.8 ± 10.9, P<0.001), (b) BMI (27.4 ± 5.8 vs. 25.8 ± 5.0, P < 0.001), and (c) proportion of hematuria by urine dipstick (15.8% vs. 9.3%, P < 0.001) were higher in the albuminuric group than in the nonalbuminuric group, whereas the (d) mean plasma glucose showed no significant difference (118.7 ± 42.5 vs. 115.6 ± 43.6, P = 0.172). ***P < 0.001.

Figure 3

Low awareness among Kidney Disease Screening and Awareness Program (KDSAP) participants with albuminuria and particularly in the younger age groups. Overall, 67 of 423 (15.8%) individuals were aware of having albuminuria: 7.0% in 18–39 years old, 13.5% in 40–59 years old, and 24.0% in ≥60 years old; P < 0.001.

Figure 4

Factors associated with awareness of albuminuria by multivariable logistic regression analysis. The explanatory variables in this model included race/ethnicity, self-reported history of diabetes, family history of kidney disease, self-assessments of health, dipstick hematuria, and degree of albuminuria. The data was shown as forest plot of odds ratios with 95% confidence intervals. Note: Albuminuria was dichotomized into high degree (2+ or more) or low degree (trace or 1+). Self-assessments of health were categorized into poor or fair, good, and very good or excellent.