Screening of Urinary Albumin-to-Creatinine Ratio: A Real-World Audit in Indian Outpatient
Diabetes-Care Settings
Dr. Prof. Ashok Sarin, MBBS, MD, FRCP (Edin)
Senior Consultant, Department of Nephrology, Indraprastha Apollo Hospital, Delhi NCR, India. Complete address: B/25
SDA, New Delhi, India.
Corresponding author: Dr. Prof. Ashok Sarin, Senior Consultant, Indraprastha Apollo Hospital, Delhi NCR; B/25 SDA,
New Delhi, India; [email protected]
Background: To describe the real-world distribution of urinary albumin-to-creatinine ratio (ACR) categories, reported from opportunistic screening of patients with diabetes mellitus (DM), attending outpatient diabetes-care settings across India.
Methods: This cross-sectional audit analyzed urinary ACR screening reports from a single spot test among 11,493 patients with DM across 14 Indian cities from 2024 to 2026.
Patients were classified into urinary ACR categories of <30 mg/g, 30 to 300 mg/g, or >300 mg/g. The ACR <30 mg/g category was further sub-classified into <10 mg/g and 10 to 29 mg/g subgroups. Data are summarized descriptively, as counts and percentages.
Results: Of the 11,493 patients screened with a single spot-test, 8,142 (70.8%) were reported with ACR <30 mg/g, 2,182 (19.0%) with ACR 30 to 300 mg/g, and 1,169 (10.2%) with ACR >300 mg/g. Overall, 3,351 patients (29.2%) had urinary ACR at or above the 30 mg/g threshold. Within the ACR <30 mg/g category, 2,382 patients (20.7% of the total) had ACR <10 mg/g while 5,760 (50.1% of the
total) fell within the high-normal 10 to 29 mg/g range, making this the single largest subgroup in the cohort.
Conclusions: In this large real-world audit, roughly half of all patients with DM had urinary ACR values in the high-normal (10 to 29 mg/g) range, and
29.2% had urinary ACR ≥ 30 mg/g. Because low-grade albuminuria within the ‘normal’ range carries recognized prognostic
significance, these descriptive data have relevance for screening and monitoring of early urinary ACR in at-risk patients, in
primary and secondary care settings.
Keywords: albumin-to-creatinine ratio; albuminuria; high-normal albuminuria; diabetes mellitus; diabetic kidney disease; real-world audit; KDIGO; cardiovascular risk
