MedicalResearch.com Interview with:
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Dr. Holly Kramer[/caption]
Dr. Holly Kramer MD, MPH
Professor of Public Health Sciences and Medicine
Division of Nephrology and Hypertension
Loyola University Chicago
MedicalResearch.com: What is the background for this survey? How is UACR measured? Would you explain the significance of albumin in the urine and what creatinine represents?
Response: Approximately
36 million people live with type 2 diabetes (T2D) in the U.S. today, with cardiovascular disease (CVD) being the number one cause of death for this patient population. About
1 in 3 adults with T2D has UACR
>30 mg/g with prevalence approaching
40% in older patients.
Compared to patients with T2D alone, those with elevated UACR face:
-
- 5-times higher risk of hospitalization for heart failure
- 4-times higher risk of CV mortality
- 3-times higher risk of myocardial infarction
Interestingly, once thought of as a traditional renal biomarker, urine albumin-to-creatinine ratio (UACR)
>30 is also a critical biomarker and urgent signal of cardiovascular (CV) risk.
When checking UACR, we look at two things: the amount of albumin leaking into the urine and the creatinine level. Albumin shouldn’t be getting through the kidneys’ filters at all, so when we see a UACR
>30 mg/g, it’s a sign of systemic vascular endothelial dysfunction. So, if albumin is leaking through the blood vessels inside the kidneys, there’s also damage in the vessels across other organs, like the heart.
UACR is such an important early indicator of CV risk in T2D because even small increases follow a clear ‘rule of three’s’. Healthy kidneys secrete 3 mg/g of albumin to creatinine per day, but when it rises to 30 mg/g, a tenfold increase that signals vascular dysfunction and increasing CV risk. At 300 mg/g, another tenfold increase, the damage is more advanced, and CV risk accelerates.
Patients with eGFR >
60 BUT UACR >30 mg/g can have up to 3.6 times increased risk of CV mortality.
As a nephrologist, I’ve been vocal about the potential for this common urine test that we regularly perform, a UACR test, in helping detect CV risk, not just kidney damage, in more patients.