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Kidney Week

Abstract: PO0544

The Ratio and Difference of Urine Protein-to-Creatinine Ratio and Albumin-to-Creatinine Ratio Facilitate Risk Prediction of All-Cause Mortality: A Retrospective Cohort Study

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Chang, David R., China Medical University Hospital, Taichung, Taiwan
  • Yeh, Hung chieh, China Medical University Hospital, Taichung, Taiwan
  • Chu, Pei-Lun, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
  • Kuo, Chin-Chi, China Medical University Hospital, Taichung, Taiwan

The difference and ratio of albuminuria (defined by urine albumin-to-creatinine ratio, uACR) and proteinuria (defined by urine protein-to-creatinine ratio, uPCR) has not been systematically evaluated with relevant clinical outcomes. We aimed to assess the prognostic performance between the difference and ratio of uACR and uPCR with all-cause mortality.


This retrospective cohort study identified 2904 adult patients with concurrently measured uACR and uPCR from the same urine specimen in a tertiary medical center in Central Taiwan between January 2003 and June 2017. Urinary albumin-to-protein ratio (uAPR) was derived by dividing uACR by uPCR. Urinary non-albumin protein (uNAP) was calculated by subtracting uACR from uPCR. Conventional severity categories of uACR and uPCR were used to develop a risk matrix. We evaluated all-cause mortality based on uAPR and uNAP on a continuous scale using the multivariable Cox proportional hazards model.


For each doubling increase in uPCR, uACR, and uNAP, the adjusted hazard ratios (aHRs) of all-cause mortality were 1.29 (95% confidence interval [CI]:1.24-1.35), 1.12 (1.09-1.16), and 1.41 (1.34-1.49), respectively. Linear dose-response association with all-cause mortality was only observed with uPCR and uNAP. The 3 × 3 risk matrices revealed that patients with severe proteinuria and minimal albuminuria had the highest risk of all-cause mortality (aHR 5.25, 95% CI: 1.88, 14.63). uNAP significantly improved the discriminative performance compared to that of uPCR (c-statistics: 0.834 vs. 0.828, p=0.03).


uNAP provides better mortality prognostic assessment than uPCR and uACR.

Hazard ratios for all-cause mortality based on uPCR, uACR, uAPR, and uNAP. Solid black lines represent aHRs based on restricted cubic splines for each urinary biomarker with knots at the 10th, 50th, and 90th percentiles.


  • Private Foundation Support