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Albumin to creatinine ratio

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Overall key points

The identification of patients in the early stages of chronic kidney disease (CKD) is important to prevent progression.

The ratio of urinary albumin to creatinine (ACR) is a sensitive index of CKD.

Devices are available to test ACR at point of care, or measurement can be done in a laboratory.

Intervention thresholds for ACR differ between patients with or without diabetes.

Part 1 Background

Chronic kidney disease (CKD) is a significant economic burden for health services in the UK and is likely to remain so for decades to come, owing to the increasing prevalence of CKD in ageing populations.1

The adoption of the US National Kidney Foundation Kidney Disease Outcomes Quality Initiative's (NKF-KDOQI) classification for CKD has highlighted the importance of identifying patients in the early stages of CKD (stages one to three) because progression to established kidney failure (stage five CKD, previously termed end-stage kidney disease) is not inevitable, and further loss of nephron function can be prevented by appropriate management at an early stage.


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