Percentage of Patients with Urine Albumin Laboratory Results

Percentage of Patients with Urine Albumin Laboratory Results

Fewer Than a Third of Patients With High Blood Pressure Are Tested for Urine Albumin in Clinical Practice

In the United States, nearly half (45%) of adults have high blood pressure, or hypertension,¹ a principal or contributing cause of death for more than 472,000 people in 2017.² Hypertension and chronic kidney disease (CKD) are closely linked. Hypertension is not only among the most important risk factors for CKD but is almost always present in people with CKD, occuring in 85% to 95% of those with advanced CKD (stages 3–5).³

Albuminuria, or protein in the urine, is associated with duration and severity of hypertension and is a risk factor for CKD and CKD progression, cardiovascular events such as heart attacks and stroke, and early death.⁴ Despite guidelines to screen for albuminuria in all patients with hypertension,^5,6 urine albumin testing is not frequently done in clinical practice. In the Veterans Health Administration system, although the percentage of patients with urine albumin results was higher with increasing age, less than one-third of patients with hypertension were tested for albuminuria in 2018 (figure). 

Laboratory tests for albuminuria are reliable, simple, and relatively inexpensive. Testing is an important step to identifying CKD and evaluating risk for cardiovascular disease and kidney disease progression. This is especially needed among patients with hypertension.

References  1. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019. 2. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death, 1999–2017. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed January 7, 2019. 3. Rao MV, Qiu Y, Wang C, Bakris G. Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999–2004. Am J Kidney Dis. 2008;51(4 suppl 2):S30–S37. 4. Matsushita K, Ballew SH, Astor BC, et al. Cohort profile: the Chronic Kidney Disease Prognosis Consortium. Int J Epidemiol. 2013;42(6):1660–1668. 5. Krammer HJ, Townsend RR, Griffin K, et al. KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline. Am J Kidney Dis. 2019;73(4):437–458. 6. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–1187.