Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/52199
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Type: Journal article
Title: Postanalytical external quality assessment of urine albumin in primary health care: An international survey
Author: Aakre, K.
Thue, G.
Subramaniam-Haavik, S.
Bukve, T.
Morris, H.
Muller, M.
Lovrencic, M.
Plum, I.
Kallion, K.
Aab, A.
Kutt, M.
Gillery, P.
Schneider, N.
Horvath, A.
Onody, R.
Oosterhuis, W.
Ricos, C.
Perich, C.
Nordin, G.
Sandberg, S.
Citation: Clinical Chemistry, 2008; 54(10):1630-1636
Publisher: Amer Assoc Clinical Chemistry
Issue Date: 2008
ISSN: 0009-9147
1530-8561
Statement of
Responsibility: 
Kristin M. Aakre, Geir Thue, Sumathi Subramaniam-Haavik, Tone Bukve, Howard Morris, Mathias Müller, Marijana V. Lovrencic, Inger Plum, Kaja Kallion, Alar Aab, Marge Kutt, Philippe Gillery, Nathalie Schneider, Andrea R. Horvath, Rita Onody, Wytze Oosterhuis, Carmen Ricos, Carmen Perich, Gunnar Nordin and Sverre Sandberg
Abstract: BACKGROUND:Microalbuminuria (MA) is recognized as an important risk factor for cardiovascular and renal complications in diabetes. We sought to evaluate how screening for MA is conducted and how urine albumin (UA) results are interpreted in primary care internationally. METHODS:General practitioners (GPs) received a case history-based questionnaire depicting a male type 2 diabetes patient in whom UA testing had not been performed. Questions were related to type of urine sample used for UA testing, need for a repeat test, whether UA testing was performed in the office laboratory, and what changes in UA results were considered clinically important [critical difference (CD)]. Participants received national benchmarking feedback reports. RESULTS:We included 2078 GPs from 9 European countries. Spot urine samples were used most commonly for first time office-based testing, whereas timed collections were used to a larger extent for hospital-based repeat tests. Repeat tests were requested by 45%-77% of GPs if the first test was positive. Four different measurement units were used by 70% of participants in estimating clinically important changes in albumin values. Stated CDs varied considerably among GPs, with similar variations in each country. A median CD of 33% was considered clinically important for both improvement and deterioration in MA, corresponding to an achievable analytical imprecision of 14%, when UA is reported as an albumin/creatinine ratio. CONCLUSIONS:Guidelines on diagnosing MA are followed only partially, and should be made more practicable, addressing issues such as type of samples, measurement units, and repeat tests.
Keywords: Humans; Albuminuria; Diabetes Mellitus, Type 2; Specimen Handling; Internationality; Quality Control; Primary Health Care; Australia; Europe; Surveys and Questionnaires
RMID: 0020083058
DOI: 10.1373/clinchem.2007.100917
Appears in Collections:Molecular and Biomedical Science publications

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