Proteinuria or Albuminuria as Markers of Kidney and Cardiovascular Disease Risk

BACKGROUND: Urinary albumin-creatinine ratio (UACR) and urinary protein-creatinine ratio (UPCR) are both used in clinical practice to diagnose and monitor chronic kidney disease (CKD). Which measure exhibits stronger associations with clinical outcomes and whether this varies by patient characteristics are unknown. OBJECTIVE: To assess and compare the performance of UACR and UPCR across CKD-related clinical outcomes. DESIGN: Individual patient-level meta-analysis. SETTING: 38 research and clinical cohorts. PARTICIPANTS: 148 994 participants with same-day measurements of UACR and UPCR. MEASUREMENTS: , and glomerular disease. RESULTS: , diabetes, and glomerular disease. Associations between UACR and UPCR were generally similar for cardiovascular outcomes but favored UACR in subgroups with moderately to severely elevated UACR. LIMITATION: Assessment of UACR and UPCR in spot urine samples. CONCLUSION: Overall, UACR was more strongly associated with kidney failure than UPCR (particularly in subgroups with higher UACR), supporting the use of UACR rather than UPCR to diagnose and risk-stratify patients. PRIMARY FUNDING SOURCE: National Kidney Foundation and National Institute of Diabetes and Digestive and Kidney Diseases.