BACKGROUND: Higher urine albumin-creatinine ratio (ACR) is associated with cardiovascular disease (CVD) events, an association that is stronger than that between spot urine albumin on its own and CVD. Urine creatinine excretion is correlated with muscle mass, and low muscle mass also is associated with CVD. Whether low urine creatinine concentration in the denominator of the ACR contributes to the association of ACR with CVD is uncertain. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 6,770 community-living individuals without CVD. PREDICTORS: Spot urine albumin concentration, the reciprocal of the urine creatinine concentration (1/UCr), and ACR. OUTCOME: Incident CVD events. RESULTS: During a mean of 7.1 years of follow-up, 281 CVD events occurred. Geometric mean values for spot urine creatinine concentration, urine albumin concentration, and ACR were 95 ± 2 (SD) mg/dL, 0.7 ± 3.7 mg/dL, and 7.0 ± 3.1 mg/g. Urine creatinine concentration was lower in older, female, and low-weight individuals. Adjusted HRs per 2-fold higher increment in each urinary measure with CVD events were similar (1/UCr: 1.07 [95% CI, 0.94-1.22]; urine albumin concentration: 1.08 [95% CI, 1.01-1.14]; and ACR: 1.11 [95% CI, 1.04-1.18]). ACR ≥10 mg/g was associated more strongly with CVD events in individuals with low weight (HR for lowest vs highest tertile: 4.34 vs 1.97; P for interaction = 0.006). Low weight also modified the association of urine albumin concentration with CVD (P for interaction = 0.06), but 1/UCr did not (P for interaction = 0.9). LIMITATIONS: We lacked 24-hour urine data. CONCLUSIONS: Although ACR is associated more strongly with CVD events in persons with low body weight, this association is not driven by differences in spot urine creatinine concentration. Overall, the associations of ACR with CVD events appear to be driven primarily by urine albumin concentration and less by urine creatinine concentration. Published by Elsevier Inc.
BACKGROUND: Higher urine albumin-creatinine ratio (ACR) is associated with cardiovascular disease (CVD) events, an association that is stronger than that between spot urine albumin on its own and CVD. Urine creatinine excretion is correlated with muscle mass, and low muscle mass also is associated with CVD. Whether low urine creatinine concentration in the denominator of the ACR contributes to the association of ACR with CVD is uncertain. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 6,770 community-living individuals without CVD. PREDICTORS: Spot urine albumin concentration, the reciprocal of the urine creatinine concentration (1/UCr), and ACR. OUTCOME: Incident CVD events. RESULTS: During a mean of 7.1 years of follow-up, 281 CVD events occurred. Geometric mean values for spot urine creatinine concentration, urine albumin concentration, and ACR were 95 ± 2 (SD) mg/dL, 0.7 ± 3.7 mg/dL, and 7.0 ± 3.1 mg/g. Urine creatinine concentration was lower in older, female, and low-weight individuals. Adjusted HRs per 2-fold higher increment in each urinary measure with CVD events were similar (1/UCr: 1.07 [95% CI, 0.94-1.22]; urine albumin concentration: 1.08 [95% CI, 1.01-1.14]; and ACR: 1.11 [95% CI, 1.04-1.18]). ACR ≥10 mg/g was associated more strongly with CVD events in individuals with low weight (HR for lowest vs highest tertile: 4.34 vs 1.97; P for interaction = 0.006). Low weight also modified the association of urine albumin concentration with CVD (P for interaction = 0.06), but 1/UCr did not (P for interaction = 0.9). LIMITATIONS: We lacked 24-hour urine data. CONCLUSIONS: Although ACR is associated more strongly with CVD events in persons with low body weight, this association is not driven by differences in spot urine creatinine concentration. Overall, the associations of ACR with CVD events appear to be driven primarily by urine albumin concentration and less by urine creatinine concentration. Published by Elsevier Inc.
Authors: Elsbeth C Witte; Hiddo J Lambers Heerspink; Dick de Zeeuw; Stephan J L Bakker; Paul E de Jong; Ronald Gansevoort Journal: J Am Soc Nephrol Date: 2008-12-17 Impact factor: 10.121
Authors: Auke H Brantsma; Stephan J L Bakker; Dick de Zeeuw; Paul E de Jong; Ronald T Gansevoort Journal: J Am Soc Nephrol Date: 2008-06-04 Impact factor: 10.121
Authors: Johan Arnlöv; Jane C Evans; James B Meigs; Thomas J Wang; Caroline S Fox; Daniel Levy; Emelia J Benjamin; Ralph B D'Agostino; Ramachandran S Vasan Journal: Circulation Date: 2005-08-08 Impact factor: 29.690
Authors: Joachim H Ix; Ian H de Boer; Christina L Wassel; Michael H Criqui; Michael G Shlipak; Mary A Whooley Journal: Circulation Date: 2010-03-08 Impact factor: 29.690
Authors: Lawrence J Appel; Jackson T Wright; Tom Greene; Lawrence Y Agodoa; Brad C Astor; George L Bakris; William H Cleveland; Jeanne Charleston; Gabriel Contreras; Marquetta L Faulkner; Francis B Gabbai; Jennifer J Gassman; Lee A Hebert; Kenneth A Jamerson; Joel D Kopple; John W Kusek; James P Lash; Janice P Lea; Julia B Lewis; Michael S Lipkowitz; Shaul G Massry; Edgar R Miller; Keith Norris; Robert A Phillips; Velvie A Pogue; Otelio S Randall; Stephen G Rostand; Miroslaw J Smogorzewski; Robert D Toto; Xuelei Wang Journal: N Engl J Med Date: 2010-09-02 Impact factor: 91.245
Authors: Andrew S Levey; Paul E de Jong; Josef Coresh; Meguid El Nahas; Brad C Astor; Kunihiro Matsushita; Ron T Gansevoort; Bertram L Kasiske; Kai-Uwe Eckardt Journal: Kidney Int Date: 2010-12-08 Impact factor: 10.612
Authors: Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew Levey; Paul de Jong; Ron T Gansevoort; Marije van der Velde; Kunihiro Matsushita; Josef Coresh; Brad C Astor; Mark Woodward; Andrew S Levey; Paul E de Jong; Ron T Gansevoort; Andrew Levey; Meguid El-Nahas; Kai-Uwe Eckardt; Bertram L Kasiske; Toshiharu Ninomiya; John Chalmers; Stephen Macmahon; Marcello Tonelli; Brenda Hemmelgarn; Frank Sacks; Gary Curhan; Allan J Collins; Suying Li; Shu-Cheng Chen; K P Hawaii Cohort; Brian J Lee; Areef Ishani; James Neaton; Ken Svendsen; Johannes F E Mann; Salim Yusuf; Koon K Teo; Peggy Gao; Robert G Nelson; William C Knowler; Henk J Bilo; Hanneke Joosten; Nanno Kleefstra; K H Groenier; Priscilla Auguste; Kasper Veldhuis; Yaping Wang; Laura Camarata; Beverly Thomas; Tom Manley Journal: Kidney Int Date: 2011-02-09 Impact factor: 10.612
Authors: Leendert H Oterdoom; Ron T Gansevoort; Jan P Schouten; Paul E de Jong; Reinold O B Gans; Stephan J L Bakker Journal: Atherosclerosis Date: 2009-05-21 Impact factor: 5.162
Authors: M Kyla Shea; Kathryn Barger; Sarah L Booth; Gregory Matuszek; Mary Cushman; Emelia J Benjamin; Stephen B Kritchevsky; Daniel E Weiner Journal: Am J Clin Nutr Date: 2020-06-01 Impact factor: 7.045
Authors: Himabindu Vidula; Kiang Liu; Michael H Criqui; Moyses Szklo; Matthew Allison; Christopher Sibley; Pamela Ouyang; Russell P Tracy; Cheeling Chan; Mary M McDermott Journal: Atherosclerosis Date: 2015-09-03 Impact factor: 5.162
Authors: Nicholas Wettersten; Ronit Katz; Michael G Shlipak; Rebecca Scherzer; Sushrut S Waikar; Joachim H Ix; Michelle M Estrella Journal: Kidney Med Date: 2021-04-30
Authors: Alexander L Bullen; Ronit Katz; Alexandra K Lee; Cheryl A M Anderson; Alfred K Cheung; Pranav S Garimella; Vasantha Jotwani; William E Haley; Areef Ishani; James P Lash; Javier A Neyra; Henry Punzi; Anjay Rastogi; Erik Riessen; Rakesh Malhotra; Chirag R Parikh; Michael V Rocco; Barry M Wall; Udayan Y Bhatt; Michael G Shlipak; Joachim H Ix; Michelle M Estrella Journal: Kidney Int Date: 2019-05-07 Impact factor: 10.612
Authors: Teresa K Chen; Ronit Katz; Michelle M Estrella; Orlando M Gutierrez; Holly Kramer; Wendy S Post; Michael G Shlipak; Christina L Wassel; Carmen A Peralta Journal: J Am Heart Assoc Date: 2017-12-21 Impact factor: 5.501
Authors: Teresa K Chen; Ronit Katz; Michelle M Estrella; Wendy S Post; Holly Kramer; Jerome I Rotter; Bamidele Tayo; Josyf C Mychaleckyj; Christina L Wassel; Carmen A Peralta Journal: J Am Heart Assoc Date: 2020-08-27 Impact factor: 6.106