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Early Detection Of Chronic Kidney Disease In Diabetes Population And Hypertension In Sunrise Project In East Jakarta

Background: Hypertension and diabetes are two of the most prevalent causes of CKD. Screening for kidney disease in primary health facilities in patients with diabetes and hypertension plays a significant role in the early detection of CKD. Dipstick proteinuria is the easiest and widely used method to detect proteinuria in epidemiologic studies, and it is relatively cheaper and easier than examining the urinary ACR, however, some patients with negative proteinuria might have increased urinary albumin-to-creatinine ratio (ACR). 
Methods: This is a cross-sectional multicenter descriptive study conducted in four district’s community health centers in East Jakarta. Subjects are patients aged > 45 in community health centers and were not enrolled in their respective community health center’s Chronic Disease Management Program (Program Pengelolaan Penyakit Kronis). Patients were classified as diabetic, hypertensive, diabetic and hypertensive, and no known history of both diseases. Subjects were then examined for proteinuria using a dipstick examination. Patients with negative proteinuria were then examined for urine ACR. Data analysis was performed in this study with a univariate analysis to describe the characteristics of each variable. 
Results: There were 400 subjects included in this study. The majority of subjects were female (76%) and a large proportion of patients was aged 51-69 years (40%). Subjects have hypertension (51%), diabetes (17%), both diabetes and hypertension (26%), and no known history of both (4%). In the group of diabetes patients with negative proteinuria, urinary ACR 30-300 mg/g were found in 4 subjects (16.7%), whereas in patients with both hypertension and diabetes and negative dipstick proteinuria, urinary ACR 30-300 mg/g was found in 12 subjects (30.8%). 
Conclusion: Examination of ACR in subjects with negative dipstick proteinuria shows some subjects have increased ACR. This data should prompt further investigations in the prevalence of albuminuria and reduced glomerular filtration rate in patients with risks of CKD in primary health care settings.