Association Between Dipstick Hematuria and Elevated Albuminuria in a Hospital-Based Population with Diverse Chronic Conditions

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Abstract
Background/Objective: Albuminuria is an early marker of kidney damage and cardiovascular risk. However, data on its prevalence and association with urine dipstick parameters in heterogeneous, hospital-based populations remain limited. The objective of this study was to determine the prevalence of elevated albuminuria measured by the urine albumin-to-creatinine ratio (UACR) in a diverse patient population and evaluate associations with semi-quantitative urine dipstick parameters. Methods: This cross-sectional study included 393 adults recruited from a tertiary-care hospital setting, comprising individuals undergoing clinical evaluation and routine health assessments. Given the hospital-based recruitment and enrichment with chronic conditions, the study population represents a high-risk cohort rather than the general population. Spot urine samples were analyzed for the UACR and dipstick parameters. Elevated albuminuria was defined as a UACR ≥ 30 mg/g. Associations were assessed using chi-square tests and multivariate logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Elevated albuminuria was observed in 64% of participants. This high prevalence likely reflects the underlying clinical characteristics of the study population, including a substantial burden of chronic kidney disease and other comorbidities, and should not be interpreted as representative of population-level prevalence. Chronic kidney disease was independently associated with elevated albuminuria (aOR 3.14, 95% CI 1.12–8.86, p = 0.030), as was male sex (aOR 1.54, 95% CI 1.01–2.34, p = 0.045). Dipstick-positive blood was significantly associated with elevated albuminuria (85% vs. 60% in those without dipstick blood positivity, p = 0.005). Dipstick albumin strongly correlated with the UACR (p < 0.001), although 22% of individuals with negative dipstick albumin still had an elevated UACR. Other urine dipstick parameters were not significantly associated with elevated albuminuria. Conclusions: In this high-risk, hospital-based cohort, elevated albuminuria was common and associated with kidney disease and male sex. Dipstick blood positivity is significantly associated with albuminuria and may warrant further investigation. However, reliance on dipstick testing alone may underestimate disease burden, supporting the need for broader implementation of UACR-based screening strategies.

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