How to lower elevated serum creatinine (Creat) and albumin levels, specifically an albumin to creatinine ratio of 600?

From the Guidelines

To lower an albumin-to-creatinine ratio (ACR) of 600 mg/g, you should focus on controlling blood pressure, blood sugar, and making lifestyle modifications, starting with prescribed medications such as ACE inhibitors or ARBs, as recommended by the most recent guidelines 1. The goal is to reduce protein leakage and protect kidney function. Key interventions include:

• Taking prescribed medications such as ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs (such as losartan 50-100 mg daily) to reduce protein leakage and protect kidney function, as supported by recent studies 1.
• Maintaining tight glucose control with appropriate medications and regular monitoring if you have diabetes.
• Reducing sodium intake to less than 2,300 mg daily.
• Limiting protein consumption to 0.8 g/kg of body weight per day.
• Avoiding NSAIDs like ibuprofen which can worsen kidney function.
• Regular exercise (30 minutes of moderate activity most days) and weight management are also important.
• Drinking adequate water (about 2 liters daily) while avoiding excessive fluid intake. These interventions work by reducing pressure within the kidneys' filtering units, decreasing inflammation, and minimizing the workload on your kidneys. Regular follow-up with your healthcare provider is essential to monitor your kidney function and adjust treatments as needed, aiming for a sustained reduction in albuminuria of at least 30% to 50% and ideally achieving a uACR of <30 mg/g, as suggested by recent guidelines 1.

From the FDA Drug Label

The RENAAL study was a randomized, placebo-controlled, double-blind, multicenter study conducted worldwide in 1513 patients with type 2 diabetes with nephropathy (defined as serum creatinine 1.3 to 3.0 mg/dL in females or males ≤60 kg and 1.5 to 3. 0 mg/dL in males >60 kg and proteinuria [urinary albumin to creatinine ratio ≥300 mg/g]). Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration

To lower down albumin creatinine of 600, losartan can be used as it has been shown to reduce proteinuria by an average of 34% in patients with type 2 diabetes and nephropathy 2. The reduction in proteinuria was evident within 3 months of starting therapy.

• Key points:
  • Losartan reduces proteinuria in patients with type 2 diabetes and nephropathy
  • The reduction in proteinuria is evident within 3 months of starting therapy
  • Losartan also reduces the rate of decline in glomerular filtration rate
• Important consideration: The use of losartan should be part of a comprehensive treatment plan that includes management of blood pressure, lipid control, diabetes management, and other cardiovascular risk factors.

From the Research

Reducing Albumin Creatinine Ratio

To lower down albumin creatinine ratio of 600, several treatment options can be considered:

• Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can be used to control proteinuria in patients with chronic kidney disease (CKD) 3, 4, 5
• The combination therapy of olmesartan+temocapril had the highest probability of being the most effective treatment to reduce proteinuria in normotensive CKD patients 3
• For diabetic nephropathy, monotherapy with the ACEI enalapril seems to be the most efficacious intervention for reducing albuminuria 3
• ARBs can reduce the risk of end stage renal disease (ESRD) and doubling of the serum creatinine level in patients with diabetes and albuminuria 4

Treatment Strategies

Different treatment strategies can be employed to reduce albumin creatinine ratio:

• ACEIs, such as enalapril, can be used to reduce proteinuria in patients with microalbuminuria 6
• ARBs, such as losartan, can also be used to reduce proteinuria in patients with microalbuminuria 6
• The combination of ACEIs and ARBs does not add any further benefit in reducing proteinuria 6
• Treatment with ACEIs or ARBs should be balanced against potential harms, such as hyperkalemia and acute kidney injury 5

Patient Selection

Patient selection is crucial when deciding on a treatment strategy:

• Patients with diabetes and albuminuria can benefit from treatment with ACEIs or ARBs 4, 5
• Patients with CKD and proteinuria can also benefit from treatment with ACEIs or ARBs 3
• The presence of other comorbidities, such as hypertension, should be taken into account when selecting a treatment strategy 7