From the Guidelines
Elevated albumin-to-creatinine ratio (ACR) is primarily caused by kidney damage, but can also be independently elevated by various factors such as exercise, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension. These factors can cause a temporary increase in ACR levels, as noted in the 2020 standards of medical care in diabetes 1. Some of the key factors that can elevate ACR independently of kidney damage include:
- Exercise within 24 hours
- Infection
- Fever
- Congestive heart failure
- Marked hyperglycemia
- Menstruation
- Marked hypertension It is essential to consider these factors when interpreting ACR results, as they may not necessarily indicate kidney damage. In clinical practice, it is crucial to evaluate the underlying cause of elevated ACR and address it accordingly, while also considering the potential impact of these temporary factors. For instance, do not discontinue renin-angiotensin system blockade for minor increases in serum creatinine (<30%) in the absence of volume depletion, as stated in the 2020 standards of medical care in diabetes 1. Regular monitoring of ACR levels and consideration of these factors can help track kidney function and treatment effectiveness.
From the Research
Causes of Elevated ACR
Elevated Albumin-to-Creatinine Ratio (ACR) is a significant indicator of kidney damage and renal disease. Several factors can contribute to elevated ACR levels, including:
- Diabetes mellitus: Studies have shown that patients with diabetes are at high risk of developing kidney disease, which can lead to elevated ACR levels 2, 3, 4, 5.
- Hypertension: Uncontrolled high blood pressure can damage the kidneys and increase ACR levels 2, 3, 4.
- Renal tubular impairment: Research has indicated that high ACR levels are associated with an increased risk of renal tubular impairment in patients with type 2 diabetes 5.
- Use of certain medications: The combination of metformin and antihypertensive therapy with drugs blocking the renin-angiotensin system can increase the risk of lactic acidosis and elevated ACR levels in certain circumstances 6.
- Dehydration and acute renal failure: These conditions can precipitate metformin-associated lactic acidosis and elevate ACR levels 6.
Risk Factors for Elevated ACR
Certain factors can increase the risk of developing elevated ACR levels, including:
- Baseline ACR values: Higher baseline ACR values are associated with an increased risk of developing renal tubular impairment 5.
- Low baseline eGFR: Patients with lower baseline estimated glomerular filtration rate (eGFR) values are at higher risk of developing elevated ACR levels 5.
- Male sex: Males are at higher risk of developing renal tubular impairment and elevated ACR levels compared to females 5.