Key result
Higher albumin-to-creatinine ratios were associated with increased prevalence of anemia, acidosis, hypoalbuminemia, hyperparathyroidism, and hypertension, while lower estimated GFR was strongly associated with all evaluated complications.
Why the study?
Do albuminuria and eGFR independently associate with concurrent complications of chronic kidney disease in adults?
Cross-Sectional (n=30,528)
Yes
Do albuminuria and eGFR independently associate with concurrent complications of chronic kidney disease in adults?
Albuminuria and eGFR are differentially associated with concurrent complications of chronic kidney disease, highlighting the independent clinical relevance of albuminuria.
Cautions against eGFR-only risk assessment in CKD; leaves open whether albuminuria-targeted interventions alter complication burden.
Higher levels of albuminuria associate with increased risk for adverse outcomes independent of estimated GFR (eGFR), but whether albuminuria also associates with concurrent complications specific to chronic kidney disease (CKD) is unknown. Here, we assessed the association of spot albumin-to-creatinine ratio with anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism, and hypertension among 30,528 adult participants in NHANES 1988-1994 and 1999-2006. After multivariable adjustment including eGFR, higher albumin-to-creatinine ratios associated with anemia, acidosis, hypoalbuminemia, hyperparathyroidism, and hypertension but only weakly associated with acidosis and anemia. Furthermore, the associations between albumin-to-creatinine ratio and both anemia and acidosis were not consistent across eGFR strata. Higher albumin-to-creatinine ratio levels did not associate with hyperphosphatemia. Lower eGFR associated with higher prevalence ratios for all complications, and these associations were stronger than those observed for the albumin-to-creatinine ratio; after multivariable adjustment, however, the associations between eGFR and both hypoalbuminemia and hypertension were NS. In conclusion, albuminuria and eGFR differentially associate with complications of CKD.
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Inker et al. (2011) conducted a cross-sectional in Chronic Kidney Disease complications (n=30,528). Albumin-to-creatinine ratio (ACR) and estimated GFR (eGFR) vs. Lower ACR (<10 mg/g) and higher eGFR (≥120 or 90-119 ml/min/1.73 m2) was evaluated on Prevalence of concurrent complications of CKD (anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism, and hypertension). Higher albumin-to-creatinine ratios were associated with increased prevalence of anemia, acidosis, hypoalbuminemia, hyperparathyroidism, and hypertension, while lower estimated GFR was strongly associated with all evaluated complications.
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