Urinary proteins-to-creatinine ratio (UPCR): A cost-effective screening alternative to urinary albumin-to-creatinine ratio (UACR) for detecting increased albuminuria in type 2 diabetes in Senegal

Screening for diabetic nephropathy with the urinary albumin-to-creatinine ratio (UACR) is limited in Senegal due to high cost and low availability. This study evaluated the urinary proteins-to-creatinine ratio (UPCR) as a more accessible alternative for screening increased albuminuria in patients with type 2 diabetes. A cross-sectional study of 83 diabetic patients in two Senegalese hospitals determined an optimal UPCR threshold and assessed its performance against UACR. Results showed that UPCR was universally available and five times cheaper than UACR, which was available in only 37.5% of laboratories. An optimal UPCR threshold was identified at 191.5 mg/g, yielding an area under the curve (AUC) of 71.73%. This threshold showed better agreement with UACR (Cohen's kappa = 0.454) than the standard 150 mg/g guideline (kappa = 0.350). UPCR represents a reliable and accessible alternative for screening increased albuminuria in resource-limited settings. A population-specific threshold of 191.5 mg/g appears more appropriate and supports a two-step strategy: initial UPCR screening followed by UACR confirmation for positive cases. Key words: Type 2 diabetes, diabetic nephropathy, chronic kidney diseases, albuminuria, proteinuria.