Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009-2010.

Author(s): Saydah SH, Pavkov ME, Zhang C, Lacher DA, Eberhardt MS, Burrows NR, Narva AS, Eggers PW, Williams DE

Publication: Clin Chem, 2013, Vol. 59, Page 675-83

PubMed ID: 23315482 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared the rate of albuminuria in matched spot urine specimens collected in the mobile examination center and a subsequent first-morning void and investigated the impact of patient age and gender, diabetes, and hypertension on the agreement between the two specimens. Patients were randomly selected from the NHANES cross-sectional cohort. Urine was collected at the NHANES mobile examination center and then patients were given a urine collection kit, asked to collect a first-morning void within 10 days, and mail the specimen with the provided ice pack.  A total of 5247 matched collections were received and 812 collections were obtained in the clinic only. Albumin levels were determined by fluorescent immunoassay and creatinine by an enzymatic method on a clinical chemistry analyzer. Patients were considered to have hypertension if they stated they had previously been diagnosed as having hypertension, were on medication for hypertension, of if during the examination they had systolic blood pressure above 140 mm Hg of diastolic blood pressure >90 mm Hg.

   Summary of Findings:

   Increased ACR was found in a larger percentage of random urine specimens than first-morning urine specimens (7.7% versus 4.7%) and was in both first-morning and random urine in only 3.5% of specimens. Of those with increased ACR in the random urine, 43.5% had increased ACR in the first-morning void but the percentage was higher in males than females (53.8% versus 36.4%). The concordance of ACR status between the two specimens was higher in those over 50 years of age than younger patients (κ=0.57 versus κ=0.39), in males than females (κ=0.63 versus κ=0.41), in those with diabetes than those without (κ=0.61 versus κ=0.46), and in those with hypertension than those without (κ=0.61 versus κ=0.38). Concordance of ACR status increased with decreasing eGFR from κ=0.41 when eGFR was ≥90 to κ=0.60 when eGFR was 30-59. The ACR was strongly correlated between first-morning urine and the matched random void (r=0.826, P<0.001), but the correlation was stronger in specimens from men than women (r=0.956 versus 0.612). Similarly, albumin levels were more strongly correlated between first-morning urine and the matched random void in men than women (r=0.859 versus r=0.672).

   Biospecimens

   • Bodily Fluid - Urine

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Not specified
   • Diabetes Type 2
   • Diabetes Type 1
   • Hypertension

   Platform:

   Analyte	Technology Platform
   Small molecule	Clinical chemistry/auto analyzer
   Protein	Immunoassay

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Time of biospecimen collection	First morning Other
   Biospecimen Acquisition	Locale of biospecimen collection	At home In mobile clinic
   Preaquisition	Diagnosis/ patient condition	Diabetic Not diabetic Hypertensive Not hypertensive
   Preaquisition	Patient age	<50 years >50 years
   Preaquisition	Patient gender	Female Male

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