Clinical Biochemistry 108 (2022) 5–9

Contents lists available at ScienceDirect

Clinical Biochemistry
journal homepage: www.elsevier.com/locate/clinbiochem

Quantification of urinary albumin and -creatinine: A comparison study of

two analytical methods and their impact on albumin to creatinine ratio
Mette B. Jensen a, b, *, 1, Ingunn Viken a, c, 1, Frederikke Høgh a, Katja K. Jacobsen d
a
Department of Clinical Biochemistry, Steno Diabetes Center Copenhagen, Herlev, Denmark
b
Department of Pathology, Rigshospitalet, Copenhagen, Denmark
c
Department of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark
d
Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: Assessment of albuminuria through albumin to creatinine ratio (ACR) is a widely used method to
Urinary albumin identify and monitor kidney damage. Significant interassay differences in urinary albumin quantification have
Urinary creatinine been documented, which may affect ACR. This study was conducted to assess quantification of urinary albumin
Albumin to creatinine ratio
and urinary creatinine by two different analytical platforms, Cobas 6000 and Atellica CH 930, to examine the
Cobas 6000
Atellica CH 930
concordance of ACR stratification.
Method comparison Method: 60 urinary albumin and 60 urinary creatinine concentrations were analyzed by Cobas 6000 and Atellica
CH 930 using immunoturbidimetric assays for urinary albumin quantification and enzymatic assays for urinary
creatinine quantification. Analytical performance was evaluated using Passing Bablok regression, Bland Altman
plots, desirable specifications for inaccuracy and imprecision, and Wilcoxon test. Clinical significance was
assessed through total error allowance (TEa) and concordance of ACR categories through Cohen’s Kappa coef­
ficient. Imprecision was assessed using control material of two levels.
Results: Results were within desirable specifications for inaccuracy. Statistical differences were found (p < 0.05)
for both analytes. TEa results were exchangeable for urinary creatinine, whereas no exchangeability was found
for urinary albumin. Cohen’s Kappa confirmed an almost perfect agreement of ACRs between the two methods
(K = 0.87), testing 42 samples. Five of the 42 samples were stratified into different categories of ACR. Results
from control material were within limits of acceptable imprecision (CV < 5%).
Conclusions: The findings of the study suggest that while differences in urinary creatinine results are not clinically
significant, differences in urinary albumin results are. Despite an almost perfect agreement between the ACR
results from Cobas 6000 and Atellica CH 930, there is a risk of incorrectly understanding a patient’s kidney
disease progression.

1. Introduction
Assessment of albuminuria through albumin to creatinine ratio
(ACR) is a widely used method to identify and monitor kidney damage
[1] and is of particular importance for people diagnosed with diabetes
mellitus.
Albuminuria predicts the development of chronic kidney disease
[2–4], including diabetic nephropathy, which affects up to 50% of
people suffering from diabetes mellitus [5]. In addition, albuminuria is
associated with cardiovascular disease and hypertension [6–8] as well as
being recognized as a risk factor for increased morbidity and mortality
[2,9]. All this highlights the importance of an accurate ACR, for which
accurate quantification of urinary albumin and urinary creatinine is
necessary.
Various methods have been developed to detect albumin and creat­
inine in urine. A commonly used method to quantify urinary albumin is
immunoturbidimetry. However, even within use of immunoturbidi­
metric assays, significant differences have been found in the results
between different platforms used to detect urinary albumin [10].
Furthermore, it has been suggested that detected differences in urinary
albumin quantification have an impact on albuminuria categorization
through an ACR [10]. All this accentuates the importance and necessity

* Corresponding author.
E-mail address: mette.bech.jensen.01@regionh.dk.in (M.B. Jensen).
1
These authors share first authorship for this work.

https://doi.org/10.1016/j.clinbiochem.2022.06.014
Received 15 April 2022; Received in revised form 26 June 2022; Accepted 29 June 2022
Available online 3 July 2022
0009-9120/© 2022 The Authors. Published by Elsevier Inc. on behalf of The Canadian Society of Clinical Chemists. This is an open access article under the CC BY
license (http://creativecommons.org/licenses/by/4.0/).
M.B. Jensen et al.
of interassay assessment. However to our knowledge, no studies have
conducted a combined evaluation of urinary albumin and urinary
creatinine quantified by Cobas 6000 (Roche Diagnostics, Mannheim,
Germany) and Atellica CH 930 (Siemens, Erlangen, Germany) to eval­
uate their impact on ACR.
The aim of this study was to assess analytical agreement of urinary
albumin and urinary creatinine quantification performed by Cobas 6000
and Atellica CH 930 to determine the concordance of the methods in
stratification of urine samples into ACR categories.
2. Materials and methods
2.1. Ethics
No ethical permission was needed as this study was part of quality
assurance. All patient sensitive information was anonymised before data
was processed.
2.2. Sample selection and handling
78 urine samples, submitted by outpatients for clinical indications of
urinary albumin and urinary creatinine at Steno Diabetes Center
Copenhagen (SDCC) were collected between the 24th of March and the
9th of April 2021. Samples were selected based on their concentrations
of urinary albumin and -creatinine, as assessed by Cobas 6000 at SDCC.
Samples were selected to cover the measurement- and dilution range
for urinary albumin (<3 mg/L and > 3800 mg/L) and urinary creatinine
(<0.9 mmol/L and > 108 mmol/L) shared by both platforms.
The measuring- and dilution ranges were divided into intervals based
on concentration to achieve an even distribution of samples.
Due to the lack of samples in the high end of the measuring range not
all intervals were filled adequately. Extra samples were added to other
intervals to reach 60 urinary albumin and 60 urinary creatinine results
in total.
Each sample was inverted multiple times manually to assure well-
mixed material before being split into two aliquots of 2 mL. The ali­
quots were then stored at − 21 ◦ C for a duration of 3 to 24 days.
To maintain uniform preanalytical treatment of the aliquots, one of
the two aliquots of each sample, was kept in storage at − 21 ◦ C until
analysis at SDCC, while the other aliquot was kept on dry ice during
transportation (20 min) to Herlev Hospital and stored at − 21 ◦ C until the
day of analysis.
2.3. Method comparison
After thawing, the aliquots were centrifuged in concordance with the
applicable programs at the respective laboratories (3500×g for 5 min at
SDCC and 3800×g for 6 min at Herlev Hospital). After centrifugation,
the aliquots were analyzed in parallel by Cobas 6000 at SDCC and
Atellica CH 930 at Herlev Hospital from the 12th to the 16th of April
2021.
Aliquots were randomly selected for analysis over these five days,
with aliquots from the same sample analyzed at the two locations within
4 h of each other. Of the 78 samples, 42 samples were analyzed for both
analytes, 18 samples were analyzed for urinary creatinine, and 18
samples were analyzed for urinary albumin. These extra 18 samples for
each analyte were added to ensure that concentrations spanning the
analytical measurement range were included in the analysis for each.
During the period of analysis from the 12th to the 16th of April 2021,
the routine control results belonging to each platform (Cobas 6000;
PreciNorm PUC and PreciPath PUC (Roche Diagnostics), Atellica CH
930; ECRe_2 and uALB_2 (Siemens Healthineers), level 1 + 2) were
collected to ensure quality and reliability of sample results.
6
Clinical Biochemistry 108 (2022) 5–9
2.4. Instruments and assays
Urinary albumin was quantified by immunoturbidimetric assays on
both instruments (Roche Tina- quant Albumin Gen.2 on Cobas 6000 and
Atellica CH Microalbumin_2 on Atellica CH 930). With this method,
anti-albumin antibodies from the reagent bind to antigens in the sample
material and create antibody-antigen complexes. The antibodies used by
Cobas 6000 derive from sheep (polyclonal), whereas the antibodies from
Atellica CH 930 derive from goats (clonality not informed). The com­
plexes are measured turbidimetrically at 340 nm.
Urinary creatinine was quantified by enzymatic assays (Kreatinin
plus ver.2 on Cobas 6000 and Atellica CH 930 Enzymatic Creatinine_2
on Atellica). Both assays are based on the Fossati, Principe, and Berti
method – a colorimetric method based on hydrogen peroxide measure­
ment [11], where a series of enzymatic reactions create hydrogen
peroxide, which forms a chromogen. The chromogen was measured at
546 nm on Cobas 6000 and 596 nm on Atellica CH 930.
Both platforms have a test duration of 10 min for urinary albumin
and urinary creatinine.
The urinary creatinine analysis on Atellica CH 930 is traceable to the
National Institute of Standards and Technology (NIST) SRM967, while
the urinary creatinine analysis on Cobas 6000 is traceable to Isotope
Dilution Mass Spectrometry (IDMS). As for urinary albumin, the analysis
on Cobas 6000 is traceable to ERM-DA470k/IFCC, while the analysis on
Atellica CH 930 is traceable to an internal standard.
2.5. Imprecision
To study interassay imprecision, controls of two levels; Precinorm
PUC (Proteins in Urine/Cerebrospinal Fluid) and PreciPath PUC (Roche
Diagnostics) were also analyzed on each platform for urinary albumin
and urinary creatinine five times throughout each day of analysis (25
times over 5 days).
2.6. Data analysis
For the imprecision study, coefficient of variation (CV) was con­
ducted for each analyte on Cobas 6000 and Atellica CH 930 using
Microsoft Excel version 2008. An allowable imprecision (CV) of 5% for
both analytes implemented at the laboratory of SDCC was used to
evaluate repeatability for each platform.
For comparative analysis, linear regressions (Passing Bablok) were
performed using the R package mcr v1.2.2 in Shiny [12] to assess the
correlation between the two assays, as well as difference plots (Bland
Altman) combined with a mean bias and 95% confidence intervals (CI)
using GraphPad Prism 9. Desirable specifications for bias (B%) (16.4%
for urinary albumin, 8.7% for urinary creatinine) were used to evaluate
bias [13].
To determine any statistically significant difference between the
results from the platforms, paired analysis (Wilcoxon) was performed
using GraphPad Prism 9.
A clinically significant difference was evaluated by a total error
allowance (TEa) for urinary albumin (24.7%) and urinary creatinine
(16.9 %) and concordance between ACR categories from each platform.
TEa was calculated as follows: (1.65 × CVmax) + Biasmax.
TEacreatinine = (1.65 × 5%) + 8.7%.
TEaalbumin = (1.65 × 5%) + 16.4%.
Clinical relevance through total error (TE) was evaluated using a
criteria allowing 5% error. Hence, if 95% of the results lay within TEa,
the results from the two methods were considered exchangeable
[14,15].
ACR was conducted on samples analyzed for urinary albumin and
urinary creatinine (n = 42 samples) using the formula; ACR (mg/g) =
(urinary albumin (mg/L) * 8.84 mmol/g) / urinary creatinine (mmol/L).
M.B. Jensen et al. Clinical Biochemistry 108 (2022) 5–9

To evaluate the degree of albuminuria, ACR was divided into different the Wilcoxon test did not change significantly (p = 0.0002).
categories following the recommendations of the Danish Society of For urinary albumin, a mean bias of 14% was found (Fig. 2), which is
Nephrology (DNS) the Danish Society of Pediatrics (DPS) and the Danish just within the desirable specification for bias of 16.4 %. Cobas 6000
Society of Clinical Biochemistry (DSKB) as follows; normal to light overestimated all urinary albumin results (60 out of 60 samples) across
albuminuria (ACR: < 30 mg/g), moderate albuminuria (ACR: 30–300 the whole working range compared to Atellica CH 930, clearly visible in
mg/g), severe albuminuria (ACR: >300 mg/g), very severe albuminuria the Bland Altman plot for urinary albumin (Fig. 2). This tendency of
(ACR: 700–2200 mg/g), nephrotic albuminuria (ACR: > 2200 mg/g) overestimation by Cobas 6000 of urinary albumin supports the findings
[16]. The interval defining severe albuminuria was adjusted from ACR: of a previous study [10]. In this study, Bargnoux et al. (2014) found that
>300 mg/g to ACR: 300–700 mg/g to avoid any double categorization Roche Cobas Integra, using the same assay as Cobas 6000 (Roche Tina-
of ACR results. quant Albumin Gen.2), tended to overestimate urinary albumin con­
Cohen’s Kappa coefficient (K) was calculated to determine the centrations compared to four other immunoturbidimetric assays [10].
strength of compliance between ACR results of the two platforms using This study tested a different assay from Siemens (Siemens Flex reagent
intervals indicated by Landis and Koch [17]. cartridge MALB), and the urinary creatinine results used to calculate
K= (P(o) – P(c))/1- P(c), where P(o) stands for the relative observed ACR’s in Bargnoux et al. (2014) were measured by Architect c8000
agreement, while P(c) stands for the probability of chance agreement (IDMS-traceable Jaffe method) [10] making it difficult to compare
[17]. ACR’s as the focus of Bargnoux et al. (2014) was on urinary albumin and
not the two analytes combined.
3. Results and discussion Furthermore, a correlation coefficient (r) of 0.997 was found for
urinary albumin, showing a strong linear correlation between the two
3.1. Imprecision study assays. The Passing-Bablok regression analysis showed/revealed a slope
of 0.8773 (CI: 0.8560 to 0.8931) and an intercept of 3.410 (CI: 0.3264 to
Overall, lower mean values were found for Atellica CH 930 6.661). Finally, the results of the Wilcoxon test showed that the differ­
compared to Cobas 6000. ences between the two assays for urinary albumin were also statistically
CV results ranged from 1.775% to 2.094% for Cobas 6000, and significant (p < 0.0001). One observation was observed in an abnormal
0.696% to 3.752% for Atellica CH 930. Generally, a lower CV is seen for distance (79%) to the others, clearly visible in the Bland Altman plot for
Atellica CH 930 compared to Cobas 6000, with the exception of results urinary albumin (Fig. 2). When excluding that observation from the
for PreciNorm PUC on urine albumin, where CV for Cobas 6000 was data, the results from the Wilcoxon test did not change (p < 0.0001).
1.775% and 3.752% for Atellica CH 930 (Table 1). Compared to the
allowable CV of 5% for urinary albumin and urinary creatinine, all CVs 3.3. Clinical significance
were acceptable.
59 out of 60 differences (98%) for urinary creatinine were within the
3.2. Method comparison limits of TEa (16.9%) indicating that urinary creatinine results obtained
from the two platforms are exchangeable. For urinary albumin 54 of 60
A mean bias for urinary creatinine of − 1.26% was found (Fig. 1), differences (90%) were within limits of TEa (24.7%). Therefore urinary
well within the desirable specification for bias of 8.7%. Illustrated by the albumin results are not exchangeable.
Bland Altman plot, Atellica CH 930 tended to overestimate creatinine in TE was evaluated without the two observations with abnormal dis­
comparison to Cobas 6000 (43 out of 60 samples). This was seen espe­ tance to the others, which did not significantly impact the findings (59
cially for lower concentrations (<20 mmol/L). out of 59 differences (100%) for urinary creatinine and 54 out of 59
A correlation coefficient (r) of 0.998 was found for urinary creati­ (92%) for urinary albumin).
nine, showing a strong linear correlation between the two assays. The The calculated Cohen’s Kappa coefficient (K) confirmed an almost
performed Passing-Bablok regression analysis furthermore showed a perfect agreement of ACRs between the two methods (K = 0.87). The
slope of 1.018 (CI: 0.9928 to 1.038) and an intercept of − 0.007634 (CI: deviating observation observed in the Bland Altman plot (Fig. 2) derived
− 0.1486 to 0.1579). The Wilcoxon test indicated that the differences from one of the 42 samples out of which K was calculated. K did not
between the two assays for urinary creatinine were statistically signifi­ change when excluding this observation from the data (K = 0,87). Five
cant (p = 0.0008). out of 42 samples were however stratified into different ACR categories
One observation was observed in an abnormal distance (25%) to the by the two platforms (Table 2). Two of these were categorized as
others, clearly visible in the Bland Altman plot for urinary creatinine nephrotic syndrome (ACR: >2200 mg/g) when measured by Cobas
(Fig. 1). When excluding that observation from the data, the results from 6000. The same samples were categorized as very severe albuminuria
(ACR: 700–2200 mg/g) when measured by Atellica CH 930. Two other
Table 1
samples were classified as moderate albuminuria (ACR: 30–300 mg/g)
Mean values and CV% calculated from the imprecision study of Precinorm PUC when using results from Atellica CH 930. When using results from Cobas
and PreciPath PUC for urinary creatinine (mmol/L) and urinary albumin (mg/L) 6000, the same samples were classified as severe albuminuria (ACR:
at Cobas 6000 and Atellica CH 930. 300–700 mg/g) (Table 2). For one sample, a major difference in cate­
PreciNorm PUC PreciPath PUC
gorization was seen, where the sample was categorized as very severe
albuminuria (ACR: 700–2200 mg/g) by Cobas 6000 and as moderate
Cobas Atellica CH Cobas Atellica CH
albuminuria (ACR: 30–300 mg/g) by Atellica CH 930. With further
6000 930 6000 930
investigation, this result derives from the deviating observation of the
Urinary urinary albumin measurements, as seen in Fig. 2.
creatinine
Mean (µmol/L) 7910.08 7680.996 4259.32 4081.56
From a clinical perspective, the observed differences between the
CV (%) 1.915 0.696 2.094 1.174 urinary albumin measurements from the two platforms could have sig­
nificant consequences for biomedical assessment. Since ACR is a mea­
surement for the quantitative relation between the concentrations of two
Urinary albumin analytes, a difference between the two can alter the calculated ACR,
Mean (mg/L) 35.58 29.24 130.24 108.06 depending on the platform. Although the results in this study suggest
CV (%) 1.775 3.752 1.990 1.236 that Atellica CH 930 tends to overestimate urinary creatinine concen­
trations compared to Cobas 6000, it does not seem to equalize the

7
M.B. Jensen et al. Clinical Biochemistry 108 (2022) 5–9

Fig. 1. Passing Bablok regression (A) and Bland Altman Plot (B) for urinary creatinine measurements on Cobas 6000 and Atellica CH 930.

Fig. 2. Passing Bablok regression (A) and Bland Altman Plot (B) for the urinary albumin results from Cobas 6000 and Atellica CH 930.

Table 2
Concordance of the stratification of ACR calculated at Cobas 6000 and Atellica CH 930. Areas marked in grey show the number of samples where there is perfect
compliance between the two platforms.

differences in urinary albumin measurements when ACR is calculated (n
= 42), since lower ACRs were produced by Atellica CH 930 compared to
Cobas 6000. This issue is apparent in the samples that were stratified in
different ACR categories by the two platforms, as previously discussed.
As observed in Table 2, four of the ACR results were stratified in
lower ACR categories when analyzed at Atellica CH 930 than when
analyzed at Cobas 6000. Such differences in classification could poten­
tially lead to an incorrect understanding of the patient’s kidney disease
progression. As an example, an additional clinical examination of the
kidney function (glomerular filtration rate, GFR) is recommended with
an ACR > 300 mg/g [16]. However this study suggests that the moni­
toring and in some cases treatment of health conditions could be
dependent on which platform the sample is analyzed on. It is, however,
worth mentioning that in 37 out of 42 samples, i.e. in 88 % of the cases,
the two platforms had perfect compliance.
This study evaluates the effects of two commonly used analytical
platforms on ACR stratification including quantification of both urinary
albumin and -creatinine. It would have been preferable however, to
have a larger proportion of samples in the highest concentrations of
urinary albumin (>1000 mg/L), as it would have strengthened the
reliability of the results from the upper level of the dilution area.
Another limitation is the use of different centrifugation programs in this
study. Centrifugation before analysis of urinary albumin is recom­
mended [1,18], however, it is unclear whether the use of different

8
M.B. Jensen et al.
centrifuge programs affects albumin concentration results. Therefore, it
is feasible that the use of different centrifugation programs before
analysis might have had an effect on the results of this study. Centrifu­
gation of the samples using identical programs would eliminate this
concern.
Finally, this study highlights the need for harmonization of urinary
albumin assays by use of a well-defined human urine-based reference
material. The assays included in this study are traceable to different
reference standards, and the results were not exchangeable for urinary
albumin.
4. Conclusions
The findings of the study suggest that while differences in urinary
creatinine results are not clinically significant, differences in urinary
albumin results are. Despite an almost perfect agreement between the
ACR results from Cobas 6000 and Atellica CH 930, there is risk of
incorrectly understanding a patient’s kidney disease progression.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
The authors would like to thank Susanne Zederkopt, Biomedical
Laboratory Scientist, for useful suggestions on sample collection and
-handling, Peter Rossing, M.D., D.M.S.c. for helpful inputs in the pub­
lishing phase, as well as the department of Clinical Biochemistry at
Herlev Hospital for assistance with sample analysis.
References
[1] W.G. Miller, D.E. Bruns, G.L. Hortin, S. Sandberg, K.M. Aakre, M.J. McQueen,
Y. Itoh, J.C. Lieske, D.W. Seccombe, G. Jones, D.M. Bunk, G.C. Curhan, A.S. Narva,
National kidney disease education program-IFCC working group on
standardization of albumin in Urine, Current issues in measurement and reporting
of urinary albumin excretion, Clin. Chem. 55 (2009) 24–38, https://doi.org/
10.1373/clinchem.2008.106567.
[2] C.E. Mogensen, Microalbuminuria predicts clinical proteinuria and early mortality
in maturity-onset diabetes, N. Engl. J. Med. 310 (1984) 356–360, https://doi.org/
10.1056/NEJM198402093100605.
[3] J.C. Verhave, R.T. Gansevoort, H.L. Hillege, S.J.L. Bakker, D. De Zeeuw, P.E. de
Jong, PREVEND study group, an elevated urinary albumin excretion predicts de
novo development of renal function impairment in the general population, Kid. Int.
Suppl. (2004) S18–S21, https://doi.org/10.1111/j.1523-1755.2004.09205.x.
Clinical Biochemistry 108 (2022) 5–9
[4] D.W. Johnson, G.R.D. Jones, T.H. Mathew, M.J. Ludlow, S.J. Chadban,
T. Usherwood, K. Polkinghorne, S. Colagiuri, G. Jerums, R. Macisaac, H. Martin,
Australasian proteinuria consensus working group, chronic kidney disease and
measurement of albuminuria or proteinuria: a position statement, Med. J. Aust.
197 (2012) 224–225, https://doi.org/10.5694/mja11.11468.
[5] N.M. Selby, M.W. Taal, An updated overview of diabetic nephropathy: diagnosis,
prognosis, treatment goals and latest guidelines, Diabetes Obes. Metab. 22 (Suppl
1) (2020) 3–15, https://doi.org/10.1111/dom.14007.
[6] A.H. Brantsma, S.J.L. Bakker, H.L. Hillege, D. de Zeeuw, P.E. de Jong, R.
T. Gansevoort, for the PREVEND study group, cardiovascular and renal outcome in
subjects with K/DOQI stage 1–3 chronic kidney disease: the importance of urinary
albumin excretion, Nephrol. Dial. Transplant. 23 (2008) 3851–3858, https://doi.
org/10.1093/ndt/gfn356.
[7] H.C. Gerstein, J.F. Mann, Q. Yi, B. Zinman, S.F. Dinneen, B. Hoogwerf, J.P. Hallé,
J. Young, A. Rashkow, C. Joyce, S. Nawaz, S. Yusuf, HOPE study investigators,
albuminuria and risk of cardiovascular events, death, and heart failure in diabetic
and nondiabetic individuals, JAMA 286 (2001) 421–426, https://doi.org/10.1001/
jama.286.4.421.
[8] H.H. Parving, U.M. Smidt, B. Friisberg, V. Bonnevie-Nielsen, A.R. Andersen,
A prospective study of glomerular filtration rate and arterial blood pressure in
insulin-dependent diabetics with diabetic nephropathy, Diabetologia 20 (1981)
457–461, https://doi.org/10.1007/BF00253407.
[9] H. Ibsen, M.H. Olsen, K. Wachtell, K. Borch-Johnsen, L.H. Lindholm, C.
E. Mogensen, B. Dahlöf, R.B. Devereux, U. de Faire, F. Fyhrquist, S. Julius, S.
E. Kjeldsen, O. Lederballe-Pedersen, M.S. Nieminen, P. Omvik, S. Oparil, Y. Wan,
Reduction in albuminuria translates to reduction in cardiovascular events in
hypertensive patients: losartan intervention for endpoint reduction in hypertension
study, Hypertension 45 (2005) 198–202, https://doi.org/10.1161/01.
HYP.0000154082.72286.2a.
[10] A.-S. Bargnoux, A. Barrot, P. Fesler, N. Kuster, S. Badiou, A.-M. Dupuy, J. Ribstein,
J.-P. Cristol, Evaluation of five immunoturbidimetric assays for urinary albumin
quantification and their impact on albuminuria categorization, Clin. Biochem. 47
(2014) 250–253, https://doi.org/10.1016/j.clinbiochem.2014.07.014.
[11] P. Fossati, L. Prencipe, G. Berti, Enzymic creatinine assay: a new colorimetric
method based on hydrogen peroxide measurement, Clin. Chem. 29 (1983)
1494–1496, https://doi.org/10.1093/clinchem/29.8.1494.
[12] B. Bahar, A.F. Tuncel, E.W. Holmes, D.T. Holmes, An interactive website for
analytical method comparison and bias estimation, Clin. Biochem. 50 (2017)
1025–1029, https://doi.org/10.1016/j.clinbiochem.2017.08.008.
[13] Q.C. Westgard, Desirable Biological Variation Database specifications, Westgard.
com. (2014). https://www.westgard.com/biodatabase1.htm (accessed May 21,
2029).
[14] C.G. Fraser, Biological Variation: From Principles to Practice, Amer. Assoc. for
Clinical Chemistry, 2001.
[15] C.L. van Lint, P.J.M. van der Boog, F.P.H.T.M. Romijn, P.W. Schenk, S. van Dijk, T.
J.M. Rövekamp, A. Kessler, L. Siekmann, T.J. Rabelink, C.M. Cobbaert, Application
of a point of care creatinine device for trend monitoring in kidney transplant
patients: fit for purpose? Clin. Chem. Lab. Med. 53 (2015) 1547–1556, https://doi.
org/10.1515/cclm-2014-0932.
[16] H. Birn, A.-L. Kamper, S.A. Ladefoged, M. Neland, E. Randers, M. Rehling, B.
Reinholdt, P. Rossing, I.M. Schmidt, Kronisk nyresygdom: Analysemetoder og
klinisk evaluering. Rekommandationer for vurdering af glomerulær filtrationsrate
og albuminuri, Dansk Nefrologisk Selskab. (2015).
[17] C. Sindt, H.L. Jørgensen, Statistiske metoder i biomedicin, BoD – Books on Demand
(2017).
[18] H. Martin, Laboratory measurement of urine albumin and urine total protein in
screening for proteinuria in chronic kidney disease, Clin. Biochem. Rev. 32 (2011)
97–102. https://www.ncbi.nlm.nih.gov/pubmed/21611083.