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Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study.

ABSTRACT: The objective of this study was to compare random urine albumin-creatinine ratio (ACR) with timed urine albumin excretion rate (AER) in patients with type 1 diabetes.A total of 1186 participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study provided spot urine specimens concurrent with 4-hour timed urine collections. ACR and AER were compared using Bland-Altman plots, cross-classification of albuminuria status and its change over time, and within-person variability.Despite moderate correlation (r=0.62), ACR levels (mg/g) were lower than AER levels (mg/24 hr). This difference was greatest for men. Gender-specific estimated AER (eAER) values were empirically derived from ACR. Comparing the eAER with measured AER, agreement of prevalent microalbuminuria and macroalbuminuria classification was fair to moderate, and classification of change in albuminuria status over time was different. Intraclass correlations were 0.697 for ACR and 0.803 for AER. Effects of DCCT intensive versus conventional diabetes therapy on urine albumin excretion or classification of albuminuria were similar using the eAER versus measured AER, as were the effects of the previous glycosylated hemoglobin.Systematic differences exist between urine ACR and AER, related to gender and other determinants of muscle mass. Use of ACR (or eAER) versus AER yields differences in classification of prevalent albuminuria states and changes in albuminuria states over time. These findings support the use of consistent ascertainment methods over time and further efforts to standardize and optimally interpret measurement of urine albumin excretion.

SUBMITTER: Younes N

PROVIDER: S-EPMC2893069 | biostudies-literature | 2010 Jul

REPOSITORIES: biostudies-literature

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Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study.

Younes Naji N Cleary Patricia A PA Steffes Michael W MW de Boer Ian H IH Molitch Mark E ME Rutledge Brandy N BN Lachin John M JM Dahms William W

Clinical journal of the American Society of Nephrology : CJASN 20100506 7

<h4>Background and objectives</h4>The objective of this study was to compare random urine albumin-creatinine ratio (ACR) with timed urine albumin excretion rate (AER) in patients with type 1 diabetes.<h4>Design, setting, participants, & measurements</h4>A total of 1186 participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study provided spot urine specimens concurrent with 4-hour timed urine collections. ACR and AER were ...[more]

PMID: 20448066

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Project description:BackgroundUrine albumin-creatinine ratio (ACR) and protein-creatinine ratio (PCR) are important markers of kidney damage and are used for prognosis in persons with chronic kidney disease (CKD). Despite how commonly these measurements are done in clinical practice, relatively few studies have directly compared the performance of these 2 measures with regard to associations with clinical outcomes, which may inform clinicians about which measure of urinary protein excretion is best. We studied the association of ACR and PCR with common complications of CKD.Study designCross-sectional study.Setting & participants3,481 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study.PredictorsACR and PCR.OutcomesWe examined the association between ACR and PCR with measures of common CKD complications: serum hemoglobin, bicarbonate, parathyroid hormone, phosphorus, potassium, and albumin.MeasurementsRestricted cubic spline analyses adjusted for estimated glomerular filtration rate (eGFR; calculated by the MDRD [Modification of Diet in Renal Disease] Study equation) were performed to study the continuous association with our predictors with each outcome.ResultsMean eGFR was 43±13 (SD)mL/min/1.73 m2 and median values for PCR and ACR were 140 and 46 mg/g, respectively. In continuous analyses adjusted for eGFR, higher ACRs and PCRs were similar and both were associated with lower serum hemoglobin, bicarbonate, and albumin levels and higher parathyroid hormone, phosphorus, and potassium levels. Across all outcomes, the associations of ACR and PCR were similar, with only small absolute differences in the outcome measure. Similar associations were seen in patients with diabetes mellitus.LimitationsParticipants largely had moderate CKD with low values for ACR and PCR, so results may not be generalizable to all CKD populations.ConclusionsIn persons with CKD, ACR and PCR are relatively similar in their associations with common complications of CKD. Thus, routine measurement of PCR may provide similar information as ACR in managing immediate complications of CKD.

Dataset Information

Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study.

Publications

Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study.

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