@article{16566,
  author = {White S. and Yu R. and Craig J. and Chadban S. and Polkinghorne K. and Atkins R.},
  title = {Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community},
  abstract = {<p>
BACKGROUND: Urine dipsticks, an inexpensive accessible test for proteinuria, are widely advocated for mass screening; however, their diagnostic accuracy in the general community is largely unknown. STUDY DESIGN: Evaluation of diagnostic test accuracy in a cross-sectional cohort. SETTING &amp; PARTICIPANTS: AusDiab, a representative survey of Australian adults 25 years and older (conducted in 1999/2000). Stratified cluster random sampling from 11,247 individuals participating in the biomedical examination; complete urinalysis data available for 10,944. INDEX TEST: Urine dipsticks (Bayer Multistix), with a positive result defined as &gt;/=1+ or trace or higher protein. REFERENCE TEST: Albumin-creatinine ratio (ACR), measured on a random spot urine sample. Reference test positivity was defined as ACR &gt;/=30 mg/g or ACR &gt;/=300 mg/g. RESULTS: Numbers of participants with ACR &lt;30, 30-300, and &gt;/=300 mg/g were 10,219 (93.4%), 634 (5.8%), and 91 (0.8%), respectively. The area under the receiver operating characteristic curve (AUC) for dipstick detection of ACR &gt;/=30 mg/g was 0.8451 +/- 0.0129 (SE) in men and 0.7775 +/- 0.0131 in women (P &lt; 0.001). The AUROC for dipstick detection of ACR &gt;/=300 mg/g was 0.9904 +/- 0.0030 in men and 0.9950 +/- 0.0016 in women (P = 0.02). Dipstick result &gt;/=1+ identified ACR &gt;/=30 mg/g with 57.8% sensitivity (95% CI, 54.1%-61.4%) and 95.4% specificity (95% CI, 95.0%-95.8%) and identified ACR &gt;/=300 mg/g with 98.9% sensitivity (99% CI, 92.1%-100%) and 92.6% specificity (99% CI, 92.0%-93.3%). A dipstick result of trace or higher identified ACR &gt;/=30 mg/g with 69.4% sensitivity (95% CI, 65.9%-72.7%) and 86.8% specificity (95% CI, 86.1%-87.4%) and identified ACR &gt;/=300 mg/g with 100% sensitivity (99% CI, 94.3%-100%) and 83.7% specificity (99% CI, 82.8%-84.6%). A negative dipstick result (less than trace) had a negative predictive value of 97.6% (95% CI, 97.2%-97.9%) for ACR &gt;/=30 mg/g and a negative predictive value of 100% (99% CI, 99.9%-100%) for ACR &gt;/=300 mg/g. The probability of an ACR &gt;/=30 mg/g confirmed on laboratory investigation was 47.2% (95% CI, 43.9%-50.5%) based on a dipstick result &gt;/=1+ and 27.1% (95% CI, 25.1%-29.2%) based on a trace or higher result. LIMITATIONS: Isolated urine samples precluded assessment of test reproducibility. Urine specific gravity and pH were not recorded; therefore, the effect of urine concentration on test performance was not assessed. CONCLUSIONS: A dipstick test result &lt;1+ or less than trace has a high negative predictive value in the general community setting, with minimal risk of a missed diagnosis of macroalbuminuria. High false-positive rates emphasize the need for laboratory confirmation of positive results.
</p>
},
  year = {2011},
  journal = {American Journal of Kidney Diseases},
  volume = {58},
  edition = {2011/03/18},
  number = {1},
  pages = {19-28},
  month = {-48254475307},
  isbn = {1523-6838 (Electronic)0272-6386 (Linking)},
  note = {White, Sarah LYu, RichardCraig, Jonathan CPolkinghorne, Kevan RAtkins, Robert CChadban, Steven JResearch Support, Non-U.S. Gov'tUnited StatesAmerican journal of kidney diseases : the official journal of the National Kidney FoundationAm J Kidney Dis. 2011 Jul;58(1):19-28. Epub 2011 Mar 15.},
  language = {eng},
}