ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Abstract: FR-PO199

The Association of Blood Urea Nitrogen to Creatinine Ratio with Renal and Cardiovascular Outcomes in CKD: The CRIC Study

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Saab, Georges, MetroHealth Medical Center, Cleveland, Ohio, United States
  • Horwitz, Edward J., MetroHealth Medical Center, Cleveland, Ohio, United States
  • Yang, Wei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Sukul, Nidhi, University of Michigan, Ann Arbor, Michigan, United States
  • Zhang, Xiaoming, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States

Above a traditional cutoff point of 20, a blood urea nitrogen to creatinine ratio (BUN/Cr) has been suggested to be a marker of neurohormonal activation (NHA) which could contribute to progressive chronic kidney disease (CKD), cardiovascular disease (CVD) and higher mortality. We therefore examined the association of baseline BUN/Cr with these outcomes among persons with CKD.



We examined 3908 adult participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. Cox regression was used to examine BUN/Cr as a categorical predictor (< 20, 20-<25, 35-<30, and >=30) and a continuous predictor using splines. Outcomes included time to end-stage renal disease (ESRD), congestive heart failure (CHF), atherosclerotic events (stroke, myocardial infarction, and peripheral artery disease), atrial fibrillation, and all-cause mortality. Cox models were adjusted demographics, clinical and laboratory characteristics.


Among the 3908 participants included in the analysis, mean age and eGFR was 57.7 (11.0) years and 44.9 (16.9) ml/min/1.73m2 respectively. Participants were 41.6% white and 45.2% female. Higher BUN/Cr was associated with increased risk of CHF, atherosclerotic events, atrial fibrillation, and overall mortality, but not with ESRD when examined as a continuous (Figure 1) or categorical predictor (Table 1)


Higher BUN/Cr is associated with an increased CVD risk and mortality but not ESRD among persons with CKD.

Table 1

Figure 1


  • NIDDK Support