Urine Albumin-to-Creatinine Ratio Reveals Kidney Disease Improving Global Outcomes Risk Reclassification in Cardiovascular-Kidney-Metabolic-Era Community Screening.

BACKGROUND: Community cardiovascular-risk programs often rely on urine dipstick testing and eGFR. How often urine albumin-to-creatinine ratio (UACR) identifies kidney-risk signals missed by these pathways is uncertain. METHODS: We conducted a cross-sectional screening-pathway analysis of the 2025 follow-up visit from a community cardiovascular high-risk project in Changzhou, China. Among 3,097 operationally eligible year-12 participants, 2,010 had first-morning void specimens with calculable UACR; 1,863 with complete UACR, eGFR, and baseline covariates were included in reclassification and strategy analyses. Elevated UACR was defined as >=30 mg/g; conventional screening as eGFR <60 ml/min per 1.73 m2 or dipstick-positive proteinuria. RESULTS: Among 2,010 participants with calculable UACR, mean age was 67 years and 923 (46%) were female. Elevated UACR was present in 737 (37%). Dipstick protein positivity had sensitivity of 34% (95% CI, 30%-37%) and specificity of 95%; 490 of 737 UACR-positive participants (66%) were dipstick-negative. Overall, 438 participants were dipstick-negative, had eGFR >=60 ml/min per 1.73 m2, and had UACR >=30 mg/g, representing 59% of elevated-UACR cases. Among 1,552 complete-case participants not flagged by conventional screening, 438 (28%) were reclassified to UACR A2/A3 and 34 (2%) to KDIGO high risk. CONCLUSIONS: In this cardiovascular high-risk community follow-up cohort, adding first-morning UACR to eGFR/dipstick screening identified substantial screening-detected albuminuria and changed KDIGO risk classification. In similar high-risk follow-up programs, quantitative UACR may be considered earlier than dipstick/eGFR-only pathways, while abnormal single-visit results require confirmation.