Prevalence and Factors Associated with Albuminuria Screening Among High-Risk Adults in Saudi Arabia: A Retrospective Cross-Sectional Study

Background: Albuminuria is a key marker for the early detection of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Despite guideline recommendations for albuminuria testing in these high-risk populations, adherence remains suboptimal. Methods: A retrospective study was conducted at a tertiary center in Al-Ahsa, Saudi Arabia. Data were collected from the records of 516 adults with diabetes mellitus, hypertension, or both. Patients with CKD were excluded. The primary outcome was the rate of albumin-to-creatinine ratio (ACR) testing. Results: Among 516 patients (mean age 63.7 ± 7.6 years), the overall prevalence of ACR testing was 59.1%. Testing was highest in the diabetes-only subgroup (69.5%), followed by the diabetes with hypertension subgroup (66.3%), and lowest in the hypertension-only subgroup (19.3%) (p< 0.001). Testing was more likely in patients with high HbA1c, more outpatient visits, and among individuals using angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. After adjustment, hypertension-only patients were less likely to be tested (adjusted odds ratio AOR = 0.14; 95% CI: 0.07– 0.31), whereas the use of ARBs (AOR = 3.17; 95% CI: 1.69– 5.93) and SGLT2 inhibitors (AOR = 3.00; 95% CI: 1.31– 6.90) was independently associated with increased testing. Of those tested, 40% had albuminuria (A2 or A3). Conclusion: Albuminuria testing is substantially underutilized among high-risk patients in Saudi Arabia. Individuals with hypertension only are the least likely to undergo screening. This suggests a gap between clinical practice and guideline recommendations. These findings highlight the need for strategies to improve early CKD detection, particularly in primary care. Keywords: albuminuria, chronic kidney disease, albumin-to-creatinine ratio, diabetes mellitus, hypertension, primary care