Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA.
Am J Kidney Dis. 2013 Oct;62(4):722-9. doi: 10.1053/j.ajkd.2013.05.010. Epub 2013 Jul 2.
Higher urine albumin-creatinine ratio (ACR) is associated with cardiovascular disease (CVD) events, an association that is stronger than that between spot urine albumin on its own and CVD. Urine creatinine excretion is correlated with muscle mass, and low muscle mass also is associated with CVD. Whether low urine creatinine concentration in the denominator of the ACR contributes to the association of ACR with CVD is uncertain.
Prospective cohort study.
SETTING & PARTICIPANTS: 6,770 community-living individuals without CVD.
Spot urine albumin concentration, the reciprocal of the urine creatinine concentration (1/UCr), and ACR.
Incident CVD events.
During a mean of 7.1 years of follow-up, 281 CVD events occurred. Geometric mean values for spot urine creatinine concentration, urine albumin concentration, and ACR were 95 ± 2 (SD) mg/dL, 0.7 ± 3.7 mg/dL, and 7.0 ± 3.1 mg/g. Urine creatinine concentration was lower in older, female, and low-weight individuals. Adjusted HRs per 2-fold higher increment in each urinary measure with CVD events were similar (1/UCr: 1.07 [95% CI, 0.94-1.22]; urine albumin concentration: 1.08 [95% CI, 1.01-1.14]; and ACR: 1.11 [95% CI, 1.04-1.18]). ACR ≥10 mg/g was associated more strongly with CVD events in individuals with low weight (HR for lowest vs highest tertile: 4.34 vs 1.97; P for interaction = 0.006). Low weight also modified the association of urine albumin concentration with CVD (P for interaction = 0.06), but 1/UCr did not (P for interaction = 0.9).
We lacked 24-hour urine data.
Although ACR is associated more strongly with CVD events in persons with low body weight, this association is not driven by differences in spot urine creatinine concentration. Overall, the associations of ACR with CVD events appear to be driven primarily by urine albumin concentration and less by urine creatinine concentration.
更高的尿白蛋白-肌酐比值（ACR）与心血管疾病（CVD）事件相关，这种关联强于单纯的尿液白蛋白斑点与 CVD 之间的关联。尿肌酐排泄与肌肉量有关，肌肉量低也与 CVD 相关。ACR 中肌酐浓度的分母低是否会导致 ACR 与 CVD 的关联尚不确定。
前瞻性队列研究。
6770 名无 CVD 的社区居住者。
尿液白蛋白浓度、尿肌酐浓度的倒数（1/UCr）和 ACR。
CVD 事件的发生。
在平均 7.1 年的随访期间，发生了 281 例 CVD 事件。尿液肌酐浓度、尿液白蛋白浓度和 ACR 的几何平均值分别为 95 ± 2（SD）mg/dL、0.7 ± 3.7 mg/dL 和 7.0 ± 3.1 mg/g。尿液肌酐浓度在年龄较大、女性和体重较轻的个体中较低。每个尿液指标与 CVD 事件的调整后的 HR 相似（1/UCr：1.07[95%CI，0.94-1.22]；尿白蛋白浓度：1.08[95%CI，1.01-1.14]；ACR：1.11[95%CI，1.04-1.18]）。在体重较轻的个体中，ACR≥10mg/g 与 CVD 事件的相关性更强（最低与最高三分位组的 HR：4.34 比 1.97；交互作用 P 值=0.006）。体重较轻也改变了尿液白蛋白浓度与 CVD 的相关性（交互作用 P 值=0.06），但 1/UCr 没有（交互作用 P 值=0.9）。
我们缺乏 24 小时尿液数据。
虽然 ACR 与体重较轻的个体的 CVD 事件相关性更强，但这种关联并不是由尿液肌酐浓度的差异驱动的。总的来说，ACR 与 CVD 事件的关联主要由尿白蛋白浓度驱动，而由尿肌酐浓度驱动的程度较小。
