Low Muscular Mass and Overestimation of Microalbuminuria by Urinary Albumin/Creatinine Ratio

Cirillo, Massimo; Laurenzi, Martino; Mancini, Mario; Zanchetti, Alberto; Santo, Natale G. De

doi:10.1161/01.hyp.0000197953.91461.95

Cited by 50 publications

(44 citation statements)

References 20 publications

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“…Prior studies demonstrated that spot-ACR is more likely to misclassify patients with lower muscle mass as having microalbuminuira (28). Similarly, at the same level of albuminuria, women have higher spot-ACR than do men (20,29,30).…”

Section: Discussionmentioning

confidence: 98%

Influence of Urine Creatinine on the Relationship between the Albumin-to-Creatinine Ratio and Cardiovascular Events

Carter

Gansevoort

Scheven

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives In the albumin-to-creatinine ratio (spot-ACR), urine creatinine corrects for tonicity but also reflects muscle mass. Low muscle mass is associated with cardiovascular disease (CVD). We hypothesized that the spot-ACR would be higher in women, lower-weight persons, and older individuals, independent of timed urine albumin excretion (24hr-UAE), and accordingly, that spot-ACR would be more strongly associated with CVD events than 24hr-UAE in these subgroups.Design, setting, participants, & methods 2627 PREVEND (Prevention of Renal and Vascular End-stage Disease) participants with 24hr-UAE ,30 mg/d were followed for CVD events for 11 years. Cox regression evaluated associations of spot-ACR and 24hr-UAE with CVD events by sex, weight, and age.Results Female sex (26%), lower weight (2% per 5 kg), and older age (4% per 5 years) were associated with higher spot-ACR independent of 24hr-UAE (P,0.001). Spot urine albumin concentration (hazard ratio [HR], 1.26 per ln-SD higher) and 1/spot urine creatinine concentration (HR, 1.16 per ln-SD higher) were associated with CVD events. Spot-ACR was more strongly associated with CVD events than either component of the ratio (HR, 1.41 per ln-SD higher). Associations of spot-ACR $10 mg/g versus less (HR, 2.33) and 24hr-UAE $10 mg/d versus less (HR, 2.09) with CVD events were similar, and there were no significant differences across subgroups (P for interactions .0.06).Conclusions In community-living individuals with 24hr-UAE ,30 mg/d, spot-ACR is higher in women, older persons, and lower-weight persons, independent of 24hr-UAE. Low spot urine creatinine is associated with CVD risk, but high urine albumin is a stronger determinant of the association of spot-ACR with CVD than is low urine creatinine.

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Section: Discussionmentioning

confidence: 98%

Influence of Urine Creatinine on the Relationship between the Albumin-to-Creatinine Ratio and Cardiovascular Events

Carter

Gansevoort

Scheven

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Advanced chronic kidney disease may be associated with a decrease in lean body mass leading to a low creatinine excretion rate. This may lead to a decreased performance of the UACR test if the same cutoffs as those used for the general population are used (29). The study presented here shows that this is not the case in the renal transplant population studied and that the 17-and 25-mg/g cutoffs for men and women proposed by previous investigators and adopted as an option by some guidelines for the general and diabetic population seem appropriate for the renal transplant population.…”

Section: Performance Measures Of Uacr For the Detection Of Albuminurimentioning

confidence: 67%

The Urine Albumin-to-Creatinine Ratio

Erman

Rahamimov

Mashraki

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Microalbuminuria predicts graft loss and death in the renal transplant population. Measurement of the urinary albumin-to-creatinine ratio (UACR) is recommended for its detection. There is uncertainty regarding the optimal UACR cutoff values. Few studies have examined the accuracy of UACR in the general population and none have been conducted in renal transplant recipients. The aim of this study is to determine the performance of UACR in the renal transplant population. Design, setting, participants & measurementsRenal transplant recipients with a daily urinary albumin excretion rate of up to 300 mg accurately carried out a 24-hour urine collection and provided a morning urine sample for the measurement of albuminuria and UACR. The performance measures of UACR for the detection of microalbuminuria (30 to 300 mg/d) were calculated using different cutoffs.Results Median albuminuria was 23 mg/d, and median UACR was 17 mg/g. The area under the receiveroperating characteristic curve was 0.94 in men and 0.98 in women. The optimal cutoff was 21 mg/g in men and 24 mg/g in women. In men, the 30-, 17-, and 21-mg/g cutoffs provided a sensitivity of 0.79, 0.89, and 0.87. In women, the 30-, 25-, and 24-mg/g cutoffs provided a sensitivity of 0.90, 0.97, and 1.0.Conclusions These data show that in the renal transplant population, lower gender-specific cutoffs should be used for the detection of microalbuminuria than the recommended 30-mg/g cutoff. These data support the need for a reappraisal of the 30-mg/g cutoff for the detection of microalbuminuria.

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“…[25][26][27] Urinary creatinine excretion was used as marker of creatinine generation. 28 Serum total calcium was expressed with correction for serum albumin concentration. 29 Acute kidney injury was defined as doubling of baseline serum creatinine or halving of baseline eGFR or low urine output.…”

Section: Methodsmentioning

confidence: 99%

“…The practical implications of the study are potentially relevant to the subgroup of hypertensives with eGFR<60 mL/ min×1.73 m 2 (ie, to a subgroup of hypertensives who account for ≤20% of hypertensives in the general population). 28,40 Within the group of hypertensives with low kidney function, the antihypertensive effect of chlorthalidone was more constant for SBP than for DBP and did not associate with adverse events in patients with higher body mass index. Thus, data point to a favorable benefit/risk ratio of chlorthalidone in patients with low kidney function, systolic hypertension, and overweight.…”

Section: Perspectivesmentioning

confidence: 95%

Parallel-Group 8-Week Study on Chlorthalidone Effects in Hypertensives With Low Kidney Function

et al. 2014

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Abstract-Short-term effects of chlorthalidone are unknown in low kidney function. The effects of 8-week treatment with 25-mg chlorthalidone on the top of ongoing treatment were compared between control hypertensives and low kidney function hypertensives as assessed by estimated glomerular filtration rate <60 mL/min×1.73 m 2 . Screening period consisted of 2 visits for patient selection and pretreatment laboratory evaluations (baseline). Inclusion criteria were uncontrolled hypertension on nondiuretic antihypertensive treatment. Exclusion criteria were chlorthalidone contraindications, refused consent, treatment with >3 antihypertensive drugs, severe hypertension, severe comorbidities, unreliable estimated glomerular filtration rate. Treatment period consisted of 5 visits (weeks 1, 2, 4, 6, and 8). Post-treatment laboratory evaluations were performed 3 to 4 days before week-8 visit. The 2 groups differed for baseline estimated glomerular filtration rate (low kidney function and control: n=60 and 60; mean, 39 and 76; range, 15-59 and 60-104) but not for sex, age, and baseline blood pressure. Week-8 blood pressure changes were a decrease in both groups (low kidney function and control: systolic pressure, −20 and −23; 95% confidence interval, −22/−18 and −26/−19; diastolic pressure, −9 and −10, −11/−7, and −13/−8) without significant between-group differences. Incidence of adverse events was similar in the 2 groups (15.0% and 16.7%). Baseline estimated glomerular filtration rate did not predict blood pressure changes and adverse events in either groups (P>0.6). In both groups, post-treatment changes were a decrease for estimated glomerular filtration rate and serum potassium, an increase for serum uric acid (P<0.01). Data show that short-term chlorthalidone effects were not reduced in hypertensives with low kidney function.

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Low Muscular Mass and Overestimation of Microalbuminuria by Urinary Albumin/Creatinine Ratio

Cited by 50 publications

References 20 publications

Influence of Urine Creatinine on the Relationship between the Albumin-to-Creatinine Ratio and Cardiovascular Events

Influence of Urine Creatinine on the Relationship between the Albumin-to-Creatinine Ratio and Cardiovascular Events

The Urine Albumin-to-Creatinine Ratio

Parallel-Group 8-Week Study on Chlorthalidone Effects in Hypertensives With Low Kidney Function

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