Biomarkers · Urine Biomarkers

Urine Albumin-to-Creatinine Ratio (uACR)

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 40% higher risk of death. We found the same pattern in NHANES

uACR and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.40×95% CI 1.37–1.42 · 50,369 adults, 7,218 deaths

Published risk of death1.63×ACR 3.4 mg/mmol vs 0.6 mg/mmol (also 1.1 mg/mmol: 1.20 (1.15-1.26); 33.9 mg/mmol: 2.22… (95% CI 1.50–1.77) · CKD Prognosis Consortium meta-analysis of 14 general population cohorts with urine ACR (105,872 participants, 730,577 person-years)

Value of the measurement+0.057gain in concordance within age bands; rank 2 of 56 · all tests

uACR by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mg/g), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	2.70	4.04	5.72	9.09	34.5	1,499	NHANES 2017-2018
All	40-59	3.07	4.44	6.74	11.3	73.3	1,633	NHANES 2017-2018
All	60+	3.52	5.67	9.12	19.3	140	1,942	NHANES 2017-2018
All	all	3.01	4.51	6.77	12.2	76.0	5,074	NHANES 2017-2018
Men	20-39	2.45	3.77	4.98	7.32	30.0	721	NHANES 2017-2018
Men	40-59	2.91	3.83	5.35	9.28	70.3	764	NHANES 2017-2018
Men	60+	3.18	5.21	8.23	18.5	177	990	NHANES 2017-2018
Men	all	2.76	3.98	5.67	10.0	73.3	2,475	NHANES 2017-2018
Women	20-39	3.22	4.76	6.72	11.4	47.4	778	NHANES 2017-2018
Women	40-59	3.78	5.36	7.66	13.0	74.5	869	NHANES 2017-2018
Women	60+	3.79	6.16	10.2	20.0	113	952	NHANES 2017-2018
Women	all	3.57	5.35	7.69	14.0	77.7	2,599	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in uACR, study by study

4 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
pharmacologic	SGLT2 inhibitors (dapagliflozin)	Dapagliflozin reduced UACR by 29·3% vs placebo (35·1% with and 14·8% without type 2 diabetes)	RCT	Jongs N, et al. Effect of dapagliflozin on urinary albumin excretion in…
pharmacologic	SGLT2 inhibitor (Dapagliflozin 10 mg)	Dapagliflozin 10 mg reduced UACR by 21·0% vs placebo at 24 weeks (95% CI -34·1 to -5·2)	RCT	Pollock C, et al. Albuminuria-lowering effect of dapagliflozin alone and in…
pharmacologic	ARB (Losartan 50-100 mg) titrated in diabetic nephropathy	Losartan reduced proteinuria by 35 percent vs placebo (P<0.001) in type 2 diabetic nephropathy	RCT	Brenner BM, et al. N Engl J Med. 2001;345:861-869.
pharmacologic	Non-steroidal MRA (Finerenone 10-20 mg)	Placebo-corrected day-90 UACR ratio 0.76 at 10 mg/d and 0.62 at 20 mg/d vs baseline (dose-dependent reduction)	RCT	Bakris GL, et al. Effect of Finerenone on Albuminuria in Patients With Diabetic…
pharmacologic	Once-weekly semaglutide 2.4 mg for 24 weeks in adults with non-diabetic CKD (eGFR >=25, UACR 30-3500 mg/g) and BMI >=27	UACR reduced 52.1% vs placebo (95% CI 33.4-65.5) at 24 weeks	RCT	Apperloo EM, Gorriz JL, Soler MJ, et al. Semaglutide in patients with…
pharmacologic	Once-weekly tirzepatide 5-15 mg compared with titrated insulin glargine over a median 85 weeks in adults with type 2 diabetes and established CVD or high risk (SURPASS-4)	UACR -6.8% with tirzepatide vs +36.9% with insulin glargine; between-group difference -31.9% (95% CI -37.7 to -25.7)	RCT	Heerspink HJL, Sattar N, Pavo I, et al. Effects of tirzepatide versus insulin…

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
clinical	Diabetic nephropathy with advanced podocytopathy	Type 2 diabetic nephropathy features albuminuria up to ≥3.0 g/g creatinine, which carried 5.2-fold renal endpoint risk vs <1.5 g/g	RCT	De Zeeuw D, et al. Kidney Int. 2004;65:2309-2320.
clinical	Uncontrolled malignant hypertension with glomerular hyperfiltration	Malignant hypertension had higher albuminuria and worse renal function than hypertension-MOD (effect size not reported)	prospective cohort	Ma H, et al. Clinical value of multiorgan damage in hypertensive crises: A…

Sources

Risk curve: Matsushita K 2010 (PMID 20483451): all-cause HR 1.63 (1.5-1.77) ACR 3.4 mg/mmol vs 0.6 mg/mmol (also 1.1 mg/mmol: 1.20 (1.15-1.26); 33.9 mg/mmol: 2.22 (1.97-2.51)). Scaled to US values (NHANES).
Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073-81.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Urine Albumin-to-Creatinine Ratio (uACR) against another biomarker.

Map uACR against another marker