Urinary Albumin-Creatinine Ratio Better Measures Risk for Kidney Failure

THURSDAY, Nov. 6, 2025 (HealthDay News) — The urinary albumin-creatinine ratio (UACR) is more strongly associated with kidney failure than the urinary protein-creatinine ratio (UPCR), according to research published online Nov. 4 in the Annals of Internal Medicine.

Hiddo J.L. Heerspink, Ph.D., from University Medical Center Groningen in the Netherlands, and colleagues examined and compared performance of UACR and UPCR across chronic kidney disease (CKD)-related clinical outcomes in an individual patient-level meta-analysis. Data were included for 148,994 participants with same-day UACR and UPCR measurements.

There were 9,773 kidney failure events during a median follow-up of 3.8 years. The researchers found that higher UACR and UPCR had a log-linear association with an increased risk for kidney failure, with a stronger association seen for UACR than UPCR (adjusted hazard ratio per standard deviation increment, 2.55 and 2.40, respectively). In subgroups with UACR greater than 30 mg/g, UPCR greater than 500 mg/g, estimated glomerular filtration rate less than 60 mL/min/1.73 m², diabetes, and glomerular disease, results were consistent to slightly stronger. For cardiovascular outcomes, associations between UACR and UPCR were generally similar, but in subgroups with moderately to severely elevated UACR, they favored UACR.

“Given increasing access to and affordability of UACR and capacity to standardize UACR assays, these data support use of UACR as the preferred measure to stratify patients at risk for CKD-related clinical outcomes,” the authors write.

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