Diagnostic accuracy of point-of-care tests for detecting albuminuria: a systematic review and meta-analysis

• Published in: Annals of internal medicine Vol. 160; no. 8; p. 550
• Main Authors: McTaggart, Malcolm P, Newall, Ronald G, Hirst, Jennifer A, Bankhead, Clare R, Lamb, Edmund J, Roberts, Nia W, Price, Christopher P
• Format: Journal Article
• Language: English
• Published: United States 15.04.2014
• Subjects: Albuminuria - diagnosis; Humans; Likelihood Functions; Point-of-Care Systems - standards; Quality Assurance, Health Care; Sensitivity and Specificity
• ISSN: 1539-3704
• DOI: 10.7326/M13-2331

Experts recommend screening for albuminuria in patients at risk for kidney disease. To systematically review evidence about the diagnostic accuracy of point-of-care (POC) tests for detecting albuminuria in individuals for whom guidelines recommend such detection. Cochrane Library, EMBASE, Medion database, MEDLINE, and Science Citation Index from 1963 through 5 December 2013; hand searches of other relevant journals; and reference lists. Cross-sectional studies, published in any language, that compared the accuracy of machine-read POC tests of urinary albumin-creatinine ratio with that of laboratory measurement. Two independent reviewers extracted study data and assessed study quality using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Sixteen studies (n = 3356 patients) that evaluated semiquantitative or quantitative POC tests and used random urine samples collected in primary or secondary ambulatory care settings met inclusion criteria. Pooling results from a bivariate random-effects model gave sensitivity and specificity estimates of 76% (95% CI, 63% to 86%) and 93% (CI, 84% to 97%), respectively, for the semiquantitative test. Sensitivity and specificity estimates for the quantitative test were 96% (CI, 78% to 99%) and 98% (CI, 93% to 99%), respectively. The negative likelihood ratios for the semiquantitative and quantitative tests were 0.26 (CI, 0.16 to 0.40) and 0.04 (CI, 0.01 to 0.25), respectively. Accuracy estimates were based on data from single-sample urine measurement, but guidelines require that diagnosis of albuminuria be based on at least 2 of 3 samples collected in a 6-month period. A negative semiquantitative POC test result does not rule out albuminuria, whereas quantitative POC testing meets required performance standards and can be used to rule out albuminuria. None.