High Albumin-to-Creatinine Ratio Associated With Increased Risk for Microalbuminuria and Future CVD in Adolescents

urine sample
urine sample
The association between albumin-to-creatinine ratio and risk for diabetic nephropathy and CVD was examined over 2 to 4 years.

Independent of hyperglycemia level, albumin-to-creatinine ratios at the higher end of the normal range for adolescents age 10 to 16 years are associated with increased risk for microalbuminuria progression and future cardiovascular disease (CVD), according to a recent study published in Diabetes Care.

In the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial, researchers stratified adolescents with type 1 diabetes into tertiles of urinary albumin-to-creatinine ratios (ACR). Baseline data revealed that participants in the normal range were already at an elevated risk for diabetic nephropathy and CVD and sought to determine whether those at the high end continued to be a higher risk over the course of the 2- to 4-year study.

Adolescents (n=150) with a mean age of 14.1 years in the high-ACR group were evaluated in addition to 396 adolescents with a mean age of 14.3 years in the mid- and low-ACR groups who participated in a parallel observational study. Each participant was measured for ACR and renal and CVD markers, as well as for carotid intima-media thickness.

By the end of the follow-up period (median of 3.9 years), microalbuminuria had developed in 31 participants; the cumulative incidence rate of microalbuminuria for the high-ACR group was 16.3%, which was significantly higher than that of the low-ACR group (5.5%; P <.001). Researchers determined that hemoglobin A1c level and baseline ACR contributed independently to microalbuminuria risk.

At baseline, carotid intima-media thickness values were comparable between the high- and low-ACR groups (0.444 mm vs 0.441 mm, respectively; P =.38). At study’s end, the average carotid intima-media thickness was significantly higher in the high-ACR group (.448 mm vs .434 mm; P =.009). Likewise, the high-ACR group demonstrated significantly greater changes in estimated glomerular filtration rate, systolic blood pressure, and high-sensitivity C-reactive protein level (P <.05).

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Researchers noted certain limitations to their study, including an inability to generalize to the broader population because the clinical trial and parallel observational study’s samples were carefully selected.

Despite its limitations, researchers said their study, “provides evidence that variations in albumin excretion in individuals with type 1 diabetes as young as 10 to 16 years old may partially predict future diabetic nephropathy and CVD risk, but the extent to which this adds to prediction based on hemoglobin A1c level and other risk factors still needs to be determined.”


Marcovecchio ML, Chiesa ST, Armitage J, et al. Renal and cardiovascular risk according to tertiles of urinary albumin-to-creatinine ratio: The adolescent type 1 diabetes cardio-renal intervention trial (AdDIT) [published online July 19, 2018]. Diabetes Care. doi: 10.2337/dc18-1125