Hiddo J.L. Heerspink, Morgan E. Grams, Yingying Sang, Shoshana H. Ballew, Josef Coresh, Aditya Surapaneni, Natália Alencar de Pinho, Nigel J. Brunskill, Alex R. Chang, Elizabeth L. Ciemins, Laura M. Dember, Keiko Kabasawa, Lindsey M. Kornowske, Adeera Levin, Rupert Major, Patrick B. Mark, Eric McArthur, James Medcalf, Marie Metzger, Girish N. Nadkarni, David Naimark, Cassianne Robinson‐Cohen, Keiichi Sumida, Robin W.M. Vernooij, Ron T. Gansevoort, Bengt Fellström, Steven J. Chadban, Elvis Akwo, Natalia Alencar de Pinho, Radica Alicic, Shoshana H. Ballew, Erwin P. Bottinger, Nigel J. Brunskill, Juan-Jesus Carrero, Steven Chadban, Alexander R. Chang, Jing Chen, Elizabeth Ciemins, Christian Combe, Josef Coresh, Kenn Daratha, Laura M. Dember, Ognjenka Djurdjev, Stephen B. Ellis, Carina Flaherty, Martin Flamant, Luc Frimat, Ron T. Gansevoort, Amit X. Garg, Morgan E. Grams, Jamie Green, Jean-Philippe Haymann, Jing He, Pascal Houillier, Yumi Ito, Cami Jones, Keiko Kabasawa, H. Lester Kirchner, Lindsey Kornowske, Csaba P. Kovesdy, Jennifer S. Lees, Andrew S. Levey, Adeera Levin, Ruth J.F. Loos, Rupert Major, Patrick B. Mark, Kunihiro Matsushita, Eric McArthur, James Medcalf, Marie Metzger, Jeff Mohl, Girish N. Nadkarni, David M.J. Naimark, Ichiei Narita, Dorothea Nitsch, Kevan Polkinghorne, Cassianne Robinson-Cohen, Yingying Sang, David Shepherd, Michael G. Shlipak, Prabin Shrestha, Gurmukteshwar Singh, James Sondheimer, Bénédicte Stengel, Michael K. Sullivan, Keiichi Sumida, Aditya Surapaneni, Junta Tanaka, Mila Tang, Navdeep Tangri, Jamie P. Traynor, Katherine Tuttle, Robin W.M. Vernooij, Angela Yee-Moon Wang, Matt Weir, Waleed Zafar
BACKGROUND: Urinary albumin-creatinine ratio (UACR) and urinary protein-creatinine ratio (UPCR) are both used in clinical practice to diagnose and monitor chronic kidney disease (CKD). Which measure exhibits stronger associations with clinical outcomes and whether this varies by patient characteristics are unknown. OBJECTIVE: To assess and compare the performance of UACR and UPCR across CKD-related clinical outcomes. DESIGN: Individual patient-level meta-analysis. SETTING: 38 research and clinical cohorts. PARTICIPANTS: 148 994 participants with same-day measurements of UACR and UPCR. MEASUREMENTS: , and glomerular disease. RESULTS: , diabetes, and glomerular disease. Associations between UACR and UPCR were generally similar for cardiovascular outcomes but favored UACR in subgroups with moderately to severely elevated UACR. LIMITATION: Assessment of UACR and UPCR in spot urine samples. CONCLUSION: Overall, UACR was more strongly associated with kidney failure than UPCR (particularly in subgroups with higher UACR), supporting the use of UACR rather than UPCR to diagnose and risk-stratify patients. PRIMARY FUNDING SOURCE: National Kidney Foundation and National Institute of Diabetes and Digestive and Kidney Diseases.