From the Guidelines
The Albumin-to-Creatinine Ratio (ACR) level should be repeated at least annually in people with chronic kidney disease (CKD), with more frequent monitoring for individuals at higher risk of CKD progression or when measurement will impact therapeutic decisions. According to the most recent guideline from Kidney International 1, the frequency of ACR testing depends on the patient's risk factors and previous results. For initial screening, patients with diabetes or hypertension should have their ACR measured annually, while those with CKD should be tested at diagnosis and then annually if the initial test is negative. Some key points to consider when monitoring ACR levels include:
- A change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation 1
- A doubling of the ACR on a subsequent test exceeds laboratory variability and warrants evaluation 1
- More frequent monitoring (every 3-6 months) is recommended for patients with rapidly progressing kidney disease or undergoing treatment adjustments, particularly if ACE inhibitors or ARBs have been initiated 1, 2
- For patients with established CKD, ACR should be measured at least annually, with more frequent monitoring for those with elevated UACR above 300 mg/g or eGFR of 30 to 60 mL/min per 1.73 m2 3 Regular monitoring of ACR is essential because it is a sensitive marker of kidney damage and cardiovascular risk, with changes often preceding declines in estimated glomerular filtration rate (eGFR) 1, 4, 2, 3.
From the Research
Albumin-to-Creatinine Ratio (ACR) Level Repeated Measurements
- The frequency of repeating the Albumin-to-Creatinine Ratio (ACR) level is crucial in managing chronic kidney disease (CKD) and type 2 diabetes (T2D) [ 5 ].
- According to guidelines, patients with T2D should undergo regular screening for CKD using spot urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) at least annually [ 5 ].
- For patients with a UACR >300 mg/g, the guidelines recommend screening at least twice a year [ 5 ].
- Regular monitoring of ACR levels can help identify CKD progression and allow for timely interventions to slow disease progression and reduce the risk of cardiovascular events and mortality [ 5 ].
Factors Influencing ACR Level Repeated Measurements
- The frequency of ACR level measurements may be influenced by factors such as CKD stage, presence of comorbidities, and medication use [ 6, 7, 8, 9 ].
- Patients with more advanced CKD stages may require more frequent monitoring of ACR levels to adjust treatment plans and prevent disease progression [ 6, 9 ].
- Medications such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may also impact ACR level measurements and require regular monitoring [ 6, 7, 8, 9 ].