Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio
An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an inde...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
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| Series: | Kidney Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059524000153 |
| _version_ | 1797213373892395008 |
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| author | Avry Chagnac Allon N. Friedman |
| author_facet | Avry Chagnac Allon N. Friedman |
| author_sort | Avry Chagnac |
| collection | DOAJ |
| description | An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists. |
| first_indexed | 2024-04-24T10:57:15Z |
| format | Article |
| id | doaj.art-3dba06c657ab423085d1c9d8f1eb901c |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-04-24T10:57:15Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-3dba06c657ab423085d1c9d8f1eb901c2024-04-12T04:45:46ZengElsevierKidney Medicine2590-05952024-04-0164100804Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine RatioAvry Chagnac0Allon N. Friedman1Maccabi Healthcare Services, Ramat Hasharon Medical Center, Israel; Address for Correspondence: Avry Chagnac, MD, Maccabi Healthcare Services, Ramat Hasharon Medical Center, 3 Ha-Netsakh St, Ramat Hasharon, 4731001 Israel.Division of Nephrology, Indiana University School of Medicine, Indianapolis, INAn increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists.http://www.sciencedirect.com/science/article/pii/S2590059524000153 |
| spellingShingle | Avry Chagnac Allon N. Friedman Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio Kidney Medicine |
| title | Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio |
| title_full | Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio |
| title_fullStr | Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio |
| title_full_unstemmed | Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio |
| title_short | Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio |
| title_sort | measuring albuminuria in individuals with obesity pitfalls of the urinary albumin creatinine ratio |
| url | http://www.sciencedirect.com/science/article/pii/S2590059524000153 |
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