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Albumin-To-Creatinine Ratio Underestimates True 24-Hour Albuminuria in Obesity: Clinical Relevance for Vascular Risk
D Moriconi1,2, M Nannipieri1, M Jadoon3
1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
In adults with obesity, the albumin-to-creatinine ratio (ACR) may underestimate albuminuria, particularly in males. Both ACR and 24-hour urinary albumin excretion (UAE) indicate early endothelial dysfunction, with UAE offering potential added value in risk assessment.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Albuminuria is a key indicator of endothelial dysfunction and cardiovascular risk.
- The albumin-to-creatinine ratio (ACR) is commonly used to measure urinary albumin excretion.
- In individuals with high fat-free mass (FFM), such as those with obesity, elevated urinary creatinine can lead to underestimation of albuminuria by ACR.
Purpose of the Study:
- To investigate the agreement between ACR and 24-hour urinary albumin excretion (UAE) in adults with severe obesity.
- To determine if discrepancies between ACR and UAE impact the detection of vascular dysfunction.
Main Methods:
- 140 individuals with severe obesity were enrolled.
- Albuminuria was assessed via spot ACR and 24-hour UAE.
- Vascular function was evaluated in a subgroup (n=70) using carotid-femoral pulse wave velocity (cf-PWV) and flow-mediated dilation (FMD).
Main Results:
- Elevated 24-hour UAE (≥30 mg/24h) was more common in males (35%) than females (20%), while ACR (≥30 mg/g) showed no sex difference.
- 15% of participants had elevated 24-hour UAE with normal ACR, a pattern more frequent in males with high FFM and urinary creatinine.
- Both ACR and UAE were independently associated with reduced FMD, indicating early endothelial dysfunction.
Conclusions:
- ACR may underestimate albuminuria in individuals with obesity, especially males.
- Despite potential underestimation by ACR, both ACR and UAE correlate with early endothelial dysfunction.
- 24-hour UAE may offer additional benefits for cardiovascular risk stratification when ACR is potentially underestimating albuminuria.
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