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        "titulo" => "Correlation versus agreement&#59; protein&#47;creatinine ratio in spot urine and 24-hour urine protein"
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">I read with interest the article by Montero et al&#46;<span class="elsevierStyleSup">1</span> in this month&#8217;s issue of Nefrolog&#237;a&#46; This was an interesting study assessing the correlation between protein&#47;creatinine ratio and 24-hour urine protein excretion&#46;&#160; The authors assessed the strength of correlation by measuring the intra-class correlation coefficient &#40;ICC&#41; and the Spearman correlation coefficient &#40;SCC&#41;&#46;</p><p class="elsevierStylePara">I would argue that although the authors did construct a Bland Altman Plot&#44; they did not address the agreement between protein&#47;creatinine ratio and 24 hour urine protein excretion exhaustively&#46; Montero et al&#46; report the 95&#37; limits of agreement graphically in the Bland-Altman plot but not numerically&#46; The authors focus on the use of intra-class correlation coefficient which is often used to assess measurement error and reliability&#46; However this measure is influenced by the amount of variation between subjects&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">When measuring urinary protein excretion&#44; all methods are extremely likely to be correlated because they will all be attempting to measure the same construct i&#46;e&#46; the amount of protein in the urine&#44; and so assessing whether the two measurements are correlated is not necessarily very informative&#46; What we are more interested in as clinicians is whether or not we can use the two methods interchangeably or the agreement&#46;</p><p class="elsevierStylePara">The standard deviation of the differences between measurements made by urine protein&#47;creatinine ratio and 24 hour urine protein excretion provides a good index of the comparability of the two methods&#46;<span class="elsevierStyleSup">2</span> This leads to the 95&#37; limits of agreement between the two measurements&#46; Although Montero et al&#46; do report the 95&#37; limits on the Bland-Altman plot&#44; perhaps the authors could have reported the 95&#37; limits of agreement for a specific number of thresholds of proteinuria for example &#60;300mg&#44; &#60;3&#46;5 grams or &#62;3&#46;5 grams individually which would be useful for clinicians trying to interpret spot urine protein&#47;creatinine ratio&#46; I worry that readers of this excellent study may be left focusing too much on correlations rather than agreement or concordance&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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