What does elevated albumin mean?

From the Guidelines

Elevated albumin levels in the urine, as indicated by an albumin-to-creatinine ratio (uACR) of 30 mg/g or higher, are a significant concern and require prompt medical attention to prevent progression to kidney disease and cardiovascular events. According to the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1, albuminuria is categorized into three stages: A1 (normal to mildly increased), A2 (moderately increased), and A3 (severely increased). The uACR is a continuous marker for cardiovascular event risk at all levels of kidney function, and the risk starts at values that are consistently above 30 mg/g.

Albuminuria Categories and CKD Classification

The albuminuria categories are defined as follows:

• A1: uACR <30 mg/g (<3 mg/mmol)
• A2: uACR 30-299 mg/g (3-29 mg/mmol)
• A3: uACR ≥300 mg/g (≥30 mg/mmol) CKD is classified based on the cause (C), glomerular filtration rate (GFR) (G), and albuminuria (A), with treatment and referral guidelines varying depending on the stage of CKD and albuminuria level.

Clinical Implications and Recommendations

The presence of elevated albuminuria, particularly at stages A2 and A3, is associated with an increased risk of cardiovascular events and progression to kidney disease. Annual albuminuria testing is recommended at the time of diabetes diagnosis, with treatment and referral guidelines based on the stage of CKD and albuminuria level. It is essential to address the underlying cause of elevated albuminuria, and treatment may involve lifestyle modifications, medication, or referral to a specialist depending on the severity of the condition.

Key Considerations

• Elevated albuminuria is a significant concern and requires prompt medical attention
• The uACR is a continuous marker for cardiovascular event risk at all levels of kidney function
• CKD is classified based on the cause, GFR, and albuminuria, with treatment and referral guidelines varying depending on the stage of CKD and albuminuria level
• Annual albuminuria testing is recommended at the time of diabetes diagnosis, with treatment and referral guidelines based on the stage of CKD and albuminuria level.

From the Research

Elevated Albumin Mean

• Elevated albumin levels, also known as hyperalbuminemia, have been associated with various health outcomes, including increased unscheduled medical visits 2.
• A study found that hyperalbuminemia patients had a higher BMI, pulse rate, and prevalence of diabetes, dyslipidemia, and brain stroke, and were more likely to have unscheduled medical visits (OR 2.35,95% CI 1.56-3.53, p < 0.001) 2.
• The relationship between albumin levels and health outcomes is complex, and albumin has a wide range of physiologic functions, including immunomodulation, endothelial stabilisation, antioxidant effects, and binding multiple drugs, toxins, and other molecules 3.
• In patients with liver cirrhosis, albumin administration is most indicated in the management of cirrhosis complications, such as fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments 4.
• The use of albumin in combination with other therapies, such as furosemide, has been shown to be effective in mobilizing refractory ascites in decompensated chronic liver disease 5.
• Tolvaptan, a drug used to treat liver cirrhosis, has been shown to be effective regardless of serum albumin level, and its use as an add-on therapy to loop diuretics can be considered an optimal therapeutic option in patients with insufficient response to loop diuretics 6.