APPLICATION OF THE MEASURED AND DERIVED URINE ALBUMIN CREATININE RATIO IN THE KIDNEY FAILURE RISK EQUATION (KFRE)

Introduction:

Albuminuria rather than proteinuria measurement has been the test preferred to identify individuals at risk. Albuminuria has been linked to cardiovascular mortality both in diabetics and non-diabetics. Guidelines endorse the use of urine albumin creatinine ratio (ACR) as the measurement of albumin is less susceptible to analytical imprecision particularly at lower levels of proteinuria. Yet, measurement of protein excretion (spot urine protein creatinine ratio (UPCR) may be the only parameter available and would need to be converted to UACR to enable use in the Kidney Failure Risk Equation (KFRE) to predict the need for Renal Replacement Therapy (RRT). Kidney failure risk equation was calculated using a 4-variable model, which includes age, gender, eGFR and UACR. The present study was designed to evaluate the prediction for RRT, based on KFRE that used the measured and derived UACR.

Methods:

This observational cross-sectional study enrolled 200 participants (after approval from Institutional Ethics Committee).Participants from CKD stage 3 to stage 5 (predialysis) were taken for the analysis . Standard biochemical tests were employed. Measurement of UPCR and UACR was done and expressed as mg/gm of creatinine. UACR was derived from UPCR utilizing the formulae provided by Weaver et al.1 KFRE was calculated with the formula provided by Tangri et al.2 Calculations using a derived value for UACR in the KFRE is designated as d(KFRE) and if the measured value of UACR is used labelled as m(KFRE). Statistical analysis was performed using appropriate tests (Spearman’s coefficient of rank correlation rho).

Results:

Conclusions:

1.      KFRE calculated from derived UACR was comparable to KFRE calculated from measured UACR at both 2 years and 5 years, holding true for KDIGO Stages 3 to 5 (predialysis).

References

1.     Weaver RG, James MT, Ravani P, Weaver CGW, Lamb EJ, Tonelli M, Manns BJ, Quinn RR, Jun M, Hemmelgarn BR. Estimating Urine Albumin-to-Creatinine Ratio from Protein-to-Creatinine Ratio: Development of Equations using Same-Day Measurements. J Am Soc Nephrol. 2020 Mar;31(3):591-601. doi: 10.1681/ASN.2019060605. Epub 2020 Feb 5. Erratum in: J Am Soc Nephrol. 2020 May;31(5):1140. doi: 10.1681/ASN.2020030291. PMID: 32024663; PMCID: PMC7062208.

2.      Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al.: A predictive model for progression of chronic kidney disease to kidney failure. JAMA 305: 1553–1559, 2011 21482743

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.