Testing how well kidneys are functioning: ACR outperforms eGFR, study suggests

This meta-analysis of 637?315 participants aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular mortality, coronary disease, stroke, and heart failure. Although creatinine-based eGFR and albuminuria (measured as albumin-to-creatinine ratio, ACR, or semi-quantitative dipstick proteinuria) independently improved cardiovascular prediction in general, the improvement was particularly evident for cardiovascular mortality and heart failure.

ACR outperformed eGFR and most of the modifiable traditional risk factors for these two outcomes, as well as stroke.

The discrimination improvement with ACR was especially evident in individuals with diabetes or hypertension but remained significant for cardiovascular mortality and heart failure even in those without either of these disorders.

As a result, the authors say that creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when they are already assessed for clinical purposes (eg, in individuals with chronic kidney disease, diabetes, or hypertension), or when cardiovascular mortality and heart failure are the outcomes of interest (eg, as stated by European guidelines for cardiovascular prevention).

ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved cardiovascular risk classification, supporting current guidelines for chronic kidney disease.

The Lancet Diabetes & Endocrinology is pleased to announce that the following paper will be published to coincide with presentation at the 52nd ERA-EDTA Congress, taking place in London, UK, May 28 -- 31, 2015.

"Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis," by Coresh et al