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Estimating Urine Albumin-to-Creatinine Ratio from Protein-to-Creatinine Ratio: Development of Equations using Same-Day Measurements.

  • Weaver, Robert G1
  • James, Matthew T1, 2
  • Ravani, Pietro1, 2
  • Weaver, Colin G W2
  • Lamb, Edmund J3
  • Tonelli, Marcello1
  • Manns, Braden J1, 2
  • Quinn, Robert R1
  • Jun, Min4
  • Hemmelgarn, Brenda R5, 2
  • 1 Departments of Medicine and.
  • 2 Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. , (Canada)
  • 3 Pathology Department, Clinical Biochemistry, East Kent Hospitals University National Health Service Trust, Canterbury, Kent, United Kingdom; and. , (United Kingdom)
  • 4 The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia. , (Australia)
  • 5 Departments of Medicine and [email protected]
Published Article
Journal of the American Society of Nephrology
American Society of Nephrology
Publication Date
Mar 01, 2020
DOI: 10.1681/ASN.2019060605
PMID: 32024663


Urine albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) are used to measure urine protein. Recent guidelines endorse ACR use, and equations have been developed incorporating ACR to predict risk of kidney failure. For situations in which PCR only is available, having a method to estimate ACR from PCR as accurately as possible would be useful. We used data from a population-based cohort of 47,714 adults in Alberta, Canada, who had simultaneous assessments of urine ACR and PCR. After log-transforming ACR and PCR, we used cubic splines and quantile regression to estimate the median ACR from a PCR, allowing for modification by specified covariates. On the basis of the cubic splines, we created models using linear splines to develop equations to estimate ACR from PCR. In a subcohort with eGFR<60 ml/min per 1.73 m2, we then used the kidney failure risk equation to compare kidney failure risk using measured ACR as well as estimated ACR that had been derived from PCR. We found a nonlinear association between log(ACR) and log(PCR), with the implied albumin-to-protein ratio increasing from <30% in normal to mild proteinuria to about 70% in severe proteinuria, and with wider prediction intervals at lower levels. Sex was the most important modifier of the relationship between ACR and PCR, with men generally having a higher albumin-to-protein ratio. Estimates of kidney failure risk were similar using measured ACR and ACR estimated from PCR. We developed equations to estimate the median ACR from a PCR, optionally including specified covariates. These equations may prove useful in certain retrospective clinical or research applications where only PCR is available. Copyright © 2020 by the American Society of Nephrology.

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