Journal Article

Evaluation of Measures of Urinary Albumin Excretion in Epidemiologic Studies

Alan R. Dyer, Philip Greenland, Paul Elliott, Martha L. Daviglus, George Claeys, Hugo Kesteloot, Hirotsugu Ueshima and Jeremiah Stamler

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 160, issue 11, pages 1122-1131
Published in print December 2004 | ISSN: 0002-9262
Published online December 2004 | e-ISSN: 1476-6256 | DOI:
Evaluation of Measures of Urinary Albumin Excretion in Epidemiologic Studies

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Twenty-four-hour urinary albumin excretion (UAE) is considered the gold standard for determining albumin level in epidemiologic studies, but this measure is inconvenient and often unavailable. Simpler alternatives include the albumin:creatinine ratio (ACR) and urinary albumin concentration (UAC) obtained from a single sample. The authors assessed the strengths and weaknesses of ACR and UAC as alternatives to UAE using albumin measurements from two 24-hour urine samples collected in 1996–1999 from 4,678 participants aged 40–59 years in the International Study of Macronutrients and Blood Pressure (17 population samples from four countries). The authors compared ACR and UAC with regard to correlations with UAE, daily within-person variability, and associations with known predictors of UAE. Rank-order correlations of ACR with UAE were 0.949 and 0.942 for men and women, respectively, versus 0.881 and 0.816 for UAC. Mean within-person coefficients of variation were 34.0–40.0% for the three measures, with the smallest values being observed for UAC. Average correlations with blood pressure were similar for UAE, ACR, and UAC, but the correlation with body mass index was lower for ACR (0.118 for ACR and 0.188 for UAC vs. 0.211 for UAE) because of high correlation between body mass index and creatinine level. Thus, UAC and ACR are acceptable alternatives to the more complex UAE, and the simpler UAC may be preferable to ACR in some respects.

Keywords: albumins; albuminuria; blood pressure; creatinine; epidemiologic methods; Abbreviations: ACR, albumin:creatinine ratio; CV, coefficient of variation; INTERMAP, International Study of Macronutrients and Blood Pressure.

Journal Article.  7120 words. 

Subjects: Public Health and Epidemiology

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