Change in urine albumin-to-creatinine ratio and clinical outcomes in patients with chronic kidney disease and type 2 diabetes
Authors' conclusion
In patients with CKD and type 2 diabetes, a >30% UACR decrease was associated with lower risk of mortality, CV events, and CKD progression, whereas a >30% UACR increase was associated with higher risk of these clinical outcomes. These findings highlight the importance of albuminuria monitoring and potential clinical benefits of targeted UACR reductions in this population.
Study context
- Population
- Adults with T2D and chronic kidney disease (CKD) with elevated urine albumin-to-creatinine ratio (UACR) (≥30 mg/g in initial testing), Optum electronic health records database (01/2007–09/2021)
- Participants
- 89,562 / 35,117 / 35,703
- Exposure
- >30% UACR decrease or >30% UACR increase vs stable UACR
- >30% UACR decreasen = 89,562
- Stable UACRn = 35,117reference
- >30% UACR increasen = 35,703
- Outcome
- All-cause mortality, composite cardiovascular (CV) outcome (CV death, MI, stroke, hospitalization for HF) and CKD progression (≥40% eGFR decline or kidney failure)
Methodological detailselectronic health records database, Cox proportional hazard models adjusted for baseline characteristics
- Electronic health records database
- Cox proportional hazard models adjusted for baseline characteristics
Main finding
As reported in the abstract
All-cause mortality
Each group vs stable UACRAdjusted hazard ratio (95% CI)P value
>30% UACR decrease
0.93(0.90–0.96)
P < 0.001>30% UACR increase
1.24(1.19–1.28)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Composite CV outcome>30% UACR decreasevs Stable UACR | 0.93 (0.90–0.95) | P < 0.001 | |
| Composite CV outcome>30% UACR increasevs Stable UACR | 1.24 (1.20–1.28) | P < 0.001 | |
| CKD progression>30% UACR decreasevs Stable UACR | 0.84 (0.81–0.86) | P < 0.001 | |
| CKD progression>30% UACR increasevs Stable UACR | 1.41 (1.36–1.46) | P < 0.001 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Change in urine albumin-to-creatinine ratio and clinical outcomes in patients with chronic kidney disease and type 2 diabetes. BMJ Open Diabetes Res Care. Published 15 October 2025. doi:10.
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