Elevated Albumin-Creatinine Ratio and Reduced eGFR Tied to CKD Progression

Pavankumar Kamat


May 03, 2021


  • The combination of increased urinary albumin-creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) was strongly associated with an increased risk of advanced chronic kidney disease (CKD) and kidney failure.

Why this matters

  • Findings warrant assessment of combined changes in UACR/eGFR as an alternative marker for kidney failure in CKD progression trials.

Study design

  • An observational cohort study included 91,319 participants (mean eGFR, 72.6 mL/min/1.73m2; median UACR, 9.7 mg/g) from the UK Clinical Practice Research Datalink (CPRD).

  • Primary outcome: advanced CKD (sustained eGFR, <30 mL/min/1.73m2).

  • Funding: NIHR Biomedical Research Centre, Oxford.

Key results

  • During a median follow-up of 2.9 years, 2541 participants progressed to advanced CKD, 379 had kidney failure, 7185 developed cardiovascular disease and 9853 died.

  • Compared with stable values:

    • ≥30% increase in UACR was associated with an increased risk of (adjusted HR [aHR]; 95% CI):

      • advanced CKD (1.78; 1.59-1.98); and

      • kidney failure (4.16; 2.74-6.32).

    • ≥30% decrease in eGFR was associated with an increased risk of (aHR; 95% CI):

      • advanced CKD (7.53; 6.70-8.45); and

      • kidney failure (5.09; 3.27-7.92).

  • Compared with stable values, a combined increase in UACR and decrease in eGFR was associated with an increased risk of (aHR; 95% CI):

    • advanced CKD (15.15; 12.43-18.46); and

    • kidney failure (16.68; 7.80-35.69).

  • Combined changes in UACR and eGFR improved the discrimination of advanced CKD better than either alone.


  • Risk of selection bias and residual confounding.


Neuen BL, Weldegiorgis M, Herrington WG, Ohkuma T, Smith M, Woodward M. Changes in GFR and Albuminuria in Routine Clinical Practice and the Risk of Kidney Disease Progression. Am J Kidney Dis. 2021 Apr 22 [Epub ahead of print]. doi: 10.1053/j.ajkd.2021.02.335. PMID: 33895181. View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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