Morning ACR 'best' for spotting renal disease in diabetes

Renal events in people with type-2 diabetes are best predicted from albumin:creatinine ratio (ACR) derived from a first-morning void, a Dutch study shows.

Hiddo Heerspink and colleagues from the University of Groingen studied 701 patients with type-2 diabetes and nephropathy.

They compared four tests for predicting renal events. Two involved from 24-hour urine collection: urinary protein excretion (UPE); urinary albumin excretion (UAE). Two used samples from patients’ first-morning void: prinary albumin concentration (UAC) and ACR.

ACR measurements were able to predict over 33% more renal outcomes than the other tests.

Writing in the Journal of the American Society of Nephrology, the researchers said: 'The ACR derived from a first-morning void displayed the strongest association with the risk for renal events.'

They added: ‘The predictive value of the first- morning void albumin:creatinine ratio was significantly higher than 24-hour urinary albumin excretion or protein excretion and confirmed the superiority of the first-morning void albumin: creatinine ratio in predicting renal events.

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