Background: Proteinuria is a major risk factor for progression in chronic kidney disease. Identification of proteinuria thus may have important implications for kidney donor prognosis in terms of risk of subsequently developing chronic kidney disease. The optimal method for identifying proteinuria in kidney donors is not known although all three methods – 24 hour collection (24hc), albumin/creatinine ratio (ACR) and protein/creatinine ratio (PCR) – are used in practice for identifying chronic kidney disease. We attempted to identify the urine protein screening method most predictive of development of metabolic syndrome(MS) as a surrogate for risk for progression to Chronic Kidney Disease (CKD).

Methods: 574 potential healthy living donors (single center) were evaluated between 2006 and 2011 for evidence of metabolic derangements consistent with the MS (HDL, triglycerides, obesity) and HTN; as well as measures of proteinuria (24hc, ACR and PCR). Clinically relevant levels of proteinuria were used to stratify donors. Sensitivities and specificities were determined for each method of proteinuria based on the number of metabolic derangements associated with the MS. Represented ethnicities were Native American, Pacific Islander/Asian, African American and Caucasian, although the majority of patients came from the latter subgroup (538 patients).

Results: Overall, 24hc of urine showed better sensitivity for detecting indices of the MS as compared to PCR. PCR was more sensitive for detecting indices of the MS than ACR.

Conclusion: Overall, 24hc showed the best sensitivity of the 3 methods of proteinuria screening to identify metabolic derangements associated with the Metabolic Syndrome.

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