MONDAY, July 19 (HealthDay News) -- To detect declining kidney performance in patients with type 2 diabetes and nephropathy, a morning urine test to determine the albumin:creatinine ratio (ACR) is superior to other urine collection and test protocols, according to a study published online July 15 in the Journal of the American Society of Nephrology.

Hiddo J. Lambers Heerspink, of the University of Groningen in the Netherlands, and colleagues compared four testing protocols used in a cohort of 701 patients with type 2 diabetes and nephropathy: protein excretion from a 24-hour urine collection sample, urinary albumin excretion from a 24-hour urine collection sample, urinary albumin concentration from a first-morning urine sample, and ACR from a first-morning urine sample. The primary outcome was end-stage renal disease or time to a doubling of serum creatinine.

During a mean 3.4 years of follow-up, the researchers found that the primary outcome occurred in 202 cases. For prediction of the primary outcome, the first-morning void ACR testing protocol was superior to the other three test protocols. The risk of a renal outcome associated with a one-standard deviation increment in the log-transformed measures was hazard ratio 4.36 for the first-morning void ACR testing protocol, while the hazard ratios for the other three tests ranged from 3.02 to 3.23.

"These results are clinically important because they imply that collection of first-morning voids, which is clearly more convenient than collecting a 24-hour urine, can be used for assessment of proteinuria," the authors write.

The Reduction of Endpoints in Non Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan trial, from which the population for this study was drawn, was sponsored by Merck & Co Inc. Several study authors disclosed financial ties to Merck.

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