CV risk: if you aren’t testing ACR, you aren’t seeing the full picture

Postgraduate Medicine, vol. 138, pp. 623–627

Abstract

Chronic kidney disease (CKD) remains a hidden epidemic, under-recognized and under-diagnosed, despite widespread recognition of the benefits of systematic screening of at-risk individuals and early diagnosis. CKD is an important driver of cardiovascular risk, even in the early stages before a diagnosis has been made. An elevated albumin-to-creatinine ratio is an independent cardiovascular (CV) risk factor, and importantly, it is modifiable. Inclusion of urinary albumin-to-creatine ratio testing enables detection of CV risk and CKD before estimated glomerular filtration rate declines and allows for implementation of guideline‑directed therapy at the earliest point where it is clinically indicated. Inclusion of urinary albumin-to-creatinine ratio as part of routine testing of at-risk individuals in standard practice would enable early intervention with guideline-directed medical therapies to optimize outcomes and alter disease progression. Individuals at risk of CKD include, but are not limited to, those with type 2 diabetes, CV disease, or hypertension, all conditions that can cause early, often silent, kidney damage. In these populations, measuring the urine albumin-to-creatinine ratio enables early detection of CKD and CV risk, allowing timely initiation of guideline-directed therapies to prevent disease progression. Although this podcast presents expert opinion, rather than original research, all recommendations are guideline-driven and evidence-based, rather than opinion-based.

Authors 4

1. Ana María Cebrián Cuenca

   Instituto Murciano de Investigación Biosanitaria

   Affiliation as printed

   Murcia Institute for Biomedical Research (IMIB)

2. David Collins. Wheeler corresponding

   University College London

   Affiliation as printed

   University College London

3. Nikolaus Marx Aachen Angiology and Internal Intensive Care Medicine

   RWTH Aachen University

   Affiliation as printed

   Angiology and Internal Intensive Care Medicine, RWTH Aachen University

4. Adeera Levin

   University of British Columbia · Provincial Health Services Authority · BC Renal

   Affiliation as printed

   BC Renal, Provincial Health Services Authority

   University of British Columbia