From the Guidelines
For patients with an Albumin-to-Creatinine Ratio (ACR) greater than 90 mg/g, the test should be repeated at least annually, but more frequent monitoring may be needed in those with higher risk of CKD progression, as suggested by the KDIGO guideline 1. The decision to repeat the test is based on individualized factors, including the etiology of disease, therapeutic regimen, and baseline UACR level.
- The KDOQI Work Group emphasizes the importance of monitoring progression of CKD using both eGFR and UACR, with more frequent monitoring in high-risk patients.
- A doubling of the UACR may exceed expected variability and warrant evaluation, according to the KDIGO guideline 1.
- The American Diabetes Association (ADA) standards of care recommend reducing ACR by 30% or greater to slow CKD progression in people with diabetes and ACR ≥ 300 mg/g.
- The frequency of UACR testing should be individualized, taking into account the patient's specific condition and risk factors, as outlined in the KDIGO guideline 1.
- For example, residual albuminuria detected while on an appropriately dosed renin angiotensin system (RAS) inhibitor and SGLT2 inhibitors should prompt a clinician to consider adding a nonsteroidal mineralocorticoid receptor antagonist in a patient with type 2 diabetes, as suggested by the KDOQI Work Group 1.
- The KDIGO guideline also suggests that a change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation, although a threshold of >30% is suggested if a hemodynamically active therapy is initiated 1.
From the Research
Repeating the Albumin-to-Creatinine Ratio (ACR) Test
- The provided studies do not directly address how soon after checking ACR with a level >90 the test should be repeated.
- However, study 2 discusses the measurement of urinary ACR in prediabetes and diabetes, and study 3 examines the association between ACR levels and the prescription of renin-angiotensin system blockade.
- Study 4 mentions that patients with a persistently elevated albumin creatinine ratio (ACR) > 10 mg/mmol despite office BP recordings < or = 140/80 mmHg on maximal recommended dose of the ACEI lisinopril were studied, but it does not provide information on when to repeat the ACR test.
- Study 5 discusses the use of angiotensin-converting enzyme inhibitors in patients with heart failure and renal insufficiency, and study 6 examines the potential detrimental effects of ACE inhibitors and angiotensin receptor blockers in CKD patients, but neither study addresses the frequency of ACR testing.
Clinical Considerations
- The decision to repeat the ACR test may depend on various clinical factors, such as the patient's underlying medical conditions, the presence of symptoms, and changes in treatment or medication.
- Study 3 suggests that albuminuria test results can influence patient care, including the prescription of ACE inhibitors or ARBs, but it does not provide guidance on the timing of repeat testing.
Limitations
- The available evidence does not provide a clear answer to the question of how soon after checking ACR with a level >90 the test should be repeated.
- Further research or clinical guidelines may be necessary to inform this decision.