Albumin-Specific Testing Outperforms Total Protein Measurement in Detecting Kidney Disease: Study
An individual patient-level meta-analysis assessed and compared the performance of urinary albumin–creatinine ratio (UACR) and urinary protein–creatinine ratio (UPCR) across chronic kidney disease (CKD)-related clinical outcomes. The analysis found that UACR was more strongly associated with development of kidney failure than UPCR, supporting the use of UACR as the preferred measure to stratify patients at risk for CKD-related outcomes. The findings are published in Annals of Internal Medicine.
Researchers from the Chronic Kidney Disease Prognosis Consortium (CKD-PC) studied data from 148,994 participants in cohorts of the CKD-PC who had UACR and UPCR measured on the same day. Cohorts are eligible to join the CKD-PC if they have sufficient data on kidney function and subsequent clinical outcomes.
The researchers quantified the associations of UACR and UPCR with outcomes including incident kidney failure with kidney replacement therapy, myocardial infarction, stroke, heart failure, and cardiovascular death. The researchers found consistent associations for both UACR and UPCR for CKD-related adverse clinical outcomes. However, UACR was more strongly associated than UPCR with incident kidney failure.
For patients with higher baseline UACR, lower estimated glomerular filtration rate (eGFR), diabetes, or glomerulonephritis, the comparative advantage of UACR was particularly strong. Associations with cardiovascular disease-related outcomes were similar for both UACR and UPCR, but subgroups with a higher baseline UACR saw somewhat stronger associations with UACR than with UPCR. The findings support the routine measurement of UACR to risk-stratify patients for CKD-related adverse outcomes.
Reference: Hiddo J.L. Heerspink, Morgan E. Grams, Yingying Sang, et al. Proteinuria or Albuminuria as Markers of Kidney and Cardiovascular Disease Risk: An Individual Patient–Level Meta-analysis. Ann Intern Med. [Epub 4 November 2025]. doi:10.7326/ANNALS-25-02117
