Abstract Body (Do not enter title and authors here): Word Count = 325

Introduction: Chronic kidney disease (CKD) is a major source of morbidity and mortality yet is underdiagnosed. Screening for CKD can include measurement of urinary albumin-to-creatinine ratio (UACR). However, the yield of elevated UACR to diagnose CKD in the US population with cardiometabolic comorbidities is not known.

Objective: We sought to investigate the prevalence of elevated UACR among high-risk populations to explore the public health benefits of UACR screening within those populations.

Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020. We included adults aged 20 years and older with available data on UACR. Elevated UACR was defined as ≥30 mg/g and was evaluated overall and among adults with a diagnosis of hypertension or diabetes, defined as self-reported diagnosis or use of medication. Elevated UACR was also evaluated across various weight statuses, including obesity (BMI ≥ 30). All analyses accounted for the NHANES complex sampling design. Chi-square analysis evaluated for differences in proportion with elevated UACR among participants with and without cardiometabolic risk factors.

Results: Among 8,644 participants representing 240,823,181 US adults, mean (standard deviation) age was 48 (18) years. Participants were 16% Hispanic, 11% non-Hispanic Black, and 63% non-Hispanic White. There was a high prevalence of obesity (41%), hypertension (32%), and diabetes (11%). In the overall sample, approximately 10% had elevated UACR. The prevalence of elevated UACR was higher in those with obesity (12%), hypertension (18%), and diabetes (31%). Chi-square analysis showed that the proportion of participants with elevated UACR was higher among adults with cardiometabolic risk factors (p<0.001).

Conclusions: A substantial proportion of US adults have elevated UACR, especially among those with cardiometabolic comorbidities, such as hypertension and diabetes. Future research should evaluate the cost-effectiveness of screening for CKD with UACR.