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American Journal of Epidemiology Advance Access published online on August 25, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj271
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received May 16, 2005
Accepted October 13, 2005

ORIGINAL CONTRIBUTIONS

Evaluation of Measures of Urinary Albumin Excretion

Ronald T. Gansevoort 1 *, Jacoline Brinkman 2, Stephan J. L. Bakker 2, Paul E. De Jong 1, and Dick de Zeeuw 2

1 Department of Nephrology, University Medical Center, Groningen, the Netherlands
2 Department of Clinical Pharmacology, University Medical Center, Groningen, the Netherlands

* To whom correspondence should be addressed.
Ronald T. Gansevoort, E-mail: R.T.Gansevoort{at}int.umcg.nl


  Abstract

Albuminuria has recently drawn much attention as a valuable risk marker for cardiovascular and renal disease progression. Albuminuria can be measured and expressed in several ways: 1) in a spot morning urine sample as urinary albumin concentration (mg/liter) or albumin:creatinine ratio (mg/mmol) and 2) in a 24-hour urine collection as urinary albumin excretion (mg/24 hours). It has not yet been clarified which measure for albuminuria is preferable in clinical practice. One of the points on which a choice should be made is which measure shows the least within-person coefficient of variation. From the perspective of their work in the Prevention of Renal and Vascular Endstage Disease Intervention Trial, 1997-2001, the authors discuss several methodological issues that are important when interpreting studies on this topic. It is argued that fresh urine should be used, since freezing at -20°C results in considerable extra variability in the albumin concentration. Furthermore, it is important to use specifically collected urine samples and not portions of a 24-hour urine sample as a surrogate for a spot morning urine sample. Albuminuria follows a circadian rhythm. Consequently, values for the within-person coefficient of variation will therefore be different when they are measured in a portion of a 24-hour urine collection in comparison with a spot morning urine sample.

Keywords: albumins; albuminuria; creatinine; epidemiologic methods.
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