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Optimal threshold of urinary albumin-to-creatinine ratio (UACR) for predicting long-term cardiovascular and noncardiovascular mortality

  • Nephrology - Original Paper
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Abstract

Purpose

Traditional cutoff values of urinary albumin-to-creatinine ratio (UACR) for predicting mortality have recently been challenged. In this study, we investigated the optimal threshold of UACR for predicting long-term cardiovascular and non-cardiovascular mortality in the general population.

Methods

Data for 25,302 adults were extracted from the National Health and Nutrition Examination Survey (2005–2014). Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of UACR for cardiovascular and non-cardiovascular mortality. A Cox regression model was established to examine the association between UACR and cardiovascular and non-cardiovascular mortality. X-tile was used to estimate the optimal cutoff of UACR.

Results

The UACR had acceptable predictive value for both cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.769 (0.711–0.828), 0.764 (0.722–0.805) and 0.763 (0.730–0.795)) and non-cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.772 (0.681–0.764), 0.708 (0.686–0.731) and 0.708 (0.690–0.725)) mortality. The optimal cutoff values were 16 and 30 mg/g for predicting long-term cardiovascular and non-cardiovascular mortality, respectively. Both cutoffs of UACR had acceptable specificity (0.785–0.891) in predicting long-term mortality, while the new proposed cutoff (16 mg/g) had higher sensitivity. The adjusted hazard ratios of cardiovascular and non-cardiovascular mortality for the high-risk group were 2.50 (95% CI 1.96–3.18, P < 0.001) and 1.92 (95% CI 1.70–2.17, P < 0.001), respectively.

Conclusions

Compared to the traditional cutoff value (30 mg/g), a UACR cutoff of 16 mg/g may be more sensitive for identifying patients at high risk for cardiovascular mortality in the general population.

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Data availability

Data are from Centers for Disease Control and Prevention, National Center for Health Statistics. National health and nutrition examination survey data. Available at: https://www.cdc.gov/nchs/nhanes/

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Funding

National Natural Science Foundation of China (grant no. 82002014), Natural Science Foundation of Guangdong Province (grant no. 2021A1515010107), the Project of Administration of Traditional Chinese Medicine of Guangdong Province of China (20221003), Science and Technology Projects of Guangzhou (grant no. 201903010097), Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (Y0120220151). The funders had no role in the study design, data collection and analysis, decision to publish, nor preparation of the manuscript.

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Author notes

  1. Zhi-wen Yang, Yan-bin Fu, and Xue-biao Wei have contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China

    Zhi-wen Yang, Yan-bin Fu, Xue-biao Wei, Bing-qi Fu, Jie-leng Huang & Dan-qing Yu

  2. Shantou University Medical College, Shantou, Guangdong, China

    Zhi-wen Yang & Bing-qi Fu

  3. Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China

    Xue-biao Wei

  4. Information and Statistics Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China

    Guan-rong Zhang

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Contributions

ZWY, WXB and YDQ contributed to the conception or design of the study. ZWY, YBF, JLH, BQF, GRZ contributed to the acquisition, analyses, and interpretation of data. ZWY, YBF, WXB drafted the manuscript. YDQ revised the manuscript critically. YDQ had all access to the data and is responsible for the overall content as guarantor. All authors contributed to refinement of the study protocol and approved the final manuscript.

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Correspondence to Dan-qing Yu.

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All NHANES study protocols survey protocol was approved by the Ethics Review Committee of NCHS of the Centers for Disease Control and Prevention.

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All participants had provided written, informed consent for the use of their data. All procedures in this study were conducted in accordance with all the relevant guidelines.

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Yang, Zw., Fu, Yb., Wei, Xb. et al. Optimal threshold of urinary albumin-to-creatinine ratio (UACR) for predicting long-term cardiovascular and noncardiovascular mortality. Int Urol Nephrol 55, 1811–1819 (2023). https://doi.org/10.1007/s11255-023-03499-z

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