Proteinuria or Albuminuria as Markers of Kidney and Cardiovascular Disease Risk

作者：Hiddo J.L. Heerspink, Morgan E. Grams, Yingying Sang, Shoshana H. Ballew, Josef Coresh, Aditya Surapaneni, Natália Alencar de Pinho, Nigel J. Brunskill, Alex R. Chang, Elizabeth L. Ciemins, Laura M. Dember, Keiko Kabasawa, Lindsey M. Kornowske, Adeera Levin, Rupert Major, Patrick B. Mark, Eric McArthur, James Medcalf, Marie Metzger, Girish N. Nadkarni, David Naimark, Cassianne Robinson‐Cohen, Keiichi Sumida, Robin W.M. Vernooij, Ron T. Gansevoort, Bengt Fellström, Steven J. Chadban, Elvis Akwo, Natalia Alencar de Pinho, Radica Alicic, Shoshana H. Ballew, Erwin P. Bottinger, Nigel J. Brunskill, Juan-Jesus Carrero, Steven Chadban, Alexander R. Chang, Jing Chen, Elizabeth Ciemins, Christian Combe, Josef Coresh, Kenn Daratha, Laura M. Dember, Ognjenka Djurdjev, Stephen B. Ellis, Carina Flaherty, Martin Flamant, Luc Frimat, Ron T. Gansevoort, Amit X. Garg, Morgan E. Grams, Jamie Green, Jean-Philippe Haymann, Jing He, Pascal Houillier, Yumi Ito, Cami Jones, Keiko Kabasawa, H. Lester Kirchner, Lindsey Kornowske, Csaba P. Kovesdy, Jennifer S. Lees, Andrew S. Levey, Adeera Levin, Ruth J.F. Loos, Rupert Major, Patrick B. Mark, Kunihiro Matsushita, Eric McArthur, James Medcalf, Marie Metzger, Jeff Mohl, Girish N. Nadkarni, David M.J. Naimark, Ichiei Narita, Dorothea Nitsch, Kevan Polkinghorne, Cassianne Robinson-Cohen, Yingying Sang, David Shepherd, Michael G. Shlipak, Prabin Shrestha, Gurmukteshwar Singh, James Sondheimer, Bénédicte Stengel, Michael K. Sullivan, Keiichi Sumida, Aditya Surapaneni, Junta Tanaka, Mila Tang, Navdeep Tangri, Jamie P. Traynor, Katherine Tuttle, Robin W.M. Vernooij, Angela Yee-Moon Wang, Matt Weir, Waleed Zafar · 发表于：Annals of Internal Medicine · 年份：2025 · DOI：10.7326/annals-25-02117 · 被引用次数：12 · 研究领域：Chronic Kidney Disease and Diabetes、Dialysis and Renal Disease Management、Sodium Intake and Health

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. Measurements:We quantified the associations of UACR and UPCR with subsequent clinical outcomes, including kidney failure and cardiovascular events, using Cox proportional hazards regression. Analyses were done in each cohort, followed by random-effects meta-analysis. Subgroups included those based on severity of proteinuria, type 2 diabetes, estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2, and glomerular disease. Results:There were 148 994 participants and 9773 kidney failure events during a median of 3.8 years of follow-up. Higher UACR and UPCR both had a log-linear association with increased risk for kidney failure. The association with kidney failure was somewhat stronger for UACR (adjusted hazard ratio [HR] per SD increment, 2.55 [95% CI, 2.36 to 2.74]) than UPCR (HR, 2.40 [CI, 2.28 to 2.53]; P for comparison<0.001). Results were consistent to slightly stronger in subgroups with UACR greater than 30 mg/g, UPCR greater than 500 mg/g, eGFR less than 60 mL/min/1.73 m2, diabetes, and glomerular disease. Associations between UACR and UPCR wer...