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ACR and eGFR predict cardiovascular risk

By Lilian Anekwe

A large meta-analysis of 21 studies of several different urine testing methods used in 1.2 million patients has found both eGFR and albumin creatinine ratio (ACR) are predictors of cardiovascular risk in the general population.

An eGFR of less than 60 mL/min/1.73m2 or an ACR of 1.1 m/mmol were both independent predictors of all-cause and cardiovascular mortality.

Compared with an eGFR of 95mL/min/1.73m2, all-cause mortality risk rose by 18, 57 and more than 300% for those with an eGRF of 60, 45 and 15 mL/min/1.73m2, respectively.

All-cause mortality risk increased linearly with ACR. Compared with an ACR of 0.6mg/mmol, the risk of all-cause mortality rose by 20% in those with an ACR of 1.1mg/mmol, by 63% for 3.4mg/mmol and more than doubled for 33.9mg/mmol.

Similar findings were recorded for cardiovascular mortality. The international study also found urine dipstick testing was nearly as predictive as ACR for stratifying risk based on albuminuria.

Professor Joseph Coresh, professor of epidemiology at John Hopkins University in Baltimore, concluded: ‘This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.

The Lancet, published online 18 May 2010

ACR and eGFR predict cardiovascular risk

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