Agreement between the ‘point of care’ tests for microalbuminuria and HbA1c performed in mexican family medicine units and the results of standard laboratory tests

Abstract

The albumin-creatinine ratio is considered an indicator of microalbuminuria, precursor to chronic kidney disease, while HbA1c is used to measure glycemic control. Given the prevalence of diabetes-related nephropathy, spot testing of albumin has long been recommended as a preventative measure, for the timely detection of microalbuminuria. However, many countries do not have this testing available in primary care, and sometimes not even in second- and third-level care. The objective of this study was to compare agreement of the microalbuminuria and HbA1c results obtained in the laboratory with ‘gold standard’ techniques, with those obtained on site with a ‘Point of Care’ DCA Vantage™ device by Siemens. Results for the albumin–creatinine ratio and HbA1c from the Siemens DCA Vantage™ point of care device were compared with those from standard laboratory tests in 25 family medicine units in Mexico City and Toluca, State of Mexico, in patients diagnosed with type-2 diabetes. Agreement between the albumin values of the 2 tests was 0.745 (CI 95% 0.655–0.812). Agreement between the two measurement techniques for HbA1c was 0.970 (CI 95% 0.966–0.973). The results obtained were sufficiently comparative (R_i= 0.74 for albumin-creatinine ratio and R_i = 0.97 for HbA1c) to justify the use of the point of care device. Given the high agreement between the point of care device and laboratory tests, this device could be used to identify chronic kidney disease and glycemic control for more adequate treatment in patients with diabetes, especially in remote areas.

Keywords:

• Microalbuminuria
• diabetic kidney disease
• type-2 diabetes
• HbA1c
• point-of-care
• albumin–creatinine ratio
• DCA Vantage
• Mexican
• primary care
• laboratory test

Acknowledgements

The authors thank Susan Drier Jonas for her assistance with the manuscript.

Disclosure statement

The authors state no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2014-785-049) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all study subjects.

Additional information

Funding

This work was supported by Pharmacur (FIS/IMSS/PROT/1632) and Fideicomiso de Investigación en Salud, IMSS (FIS/IMSS/PROT/ESP/1367, FIS/IMSS PROT PRIO/040).