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<p>The urine albumin-to-creatinine ratio (UACR) is a well-established marker for chronic kidney disease, but its utility in predicting acute kidney injury remains uncertain. This systematic review and meta-analysis aimed to evaluate predictive performance for AKI development and prognostic performance for AKI progression in hospitalized adults. A comprehensive search of Ovid MEDLINE, Embase, and CENTRAL databases identified 13 studies (n = 10,438) on AKI incidence and three studies (n = 1596) on AKI progression. Elevated UACR was associated with an increased risk of AKI (pooled OR 1.39; 95% CI 1.08–1.79) and AKI progression (pooled OR 3.76; 95% CI 2.59–5.45). The pooled sensitivity and specificity for AKI prediction were 0.71 (95% CI 0.59–0.80) and 0.67 (95% CI 0.56–0.76), respectively, with an area under the curve (AUC) of 0.74. However, there was high heterogeneity across studies, and UACR thresholds for AKI prediction varied widely. Despite these limitations, UACR appears to be a promising, low-cost biomarker for predicting AKI, particularly in high-risk settings such as cardiac surgery. Standardization of thresholds and further validation are needed to support its clinical implementation.</p>

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Predictive and prognostic performance of urinary albumin-to-creatinine ratio for acute kidney injury: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月12日

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  • Nuanprae Kitisin,
  • Jordan Ismail,
  • Nattaya Raykateeraroj,
  • Yukiko Hikasa,
  • Alessandro Caroli,
  • Jonathan Nübel,
  • Glenn Eastwood,
  • Rinaldo Bellomo,
  • Ary Serpa Neto

摘要

The urine albumin-to-creatinine ratio (UACR) is a well-established marker for chronic kidney disease, but its utility in predicting acute kidney injury remains uncertain. This systematic review and meta-analysis aimed to evaluate predictive performance for AKI development and prognostic performance for AKI progression in hospitalized adults. A comprehensive search of Ovid MEDLINE, Embase, and CENTRAL databases identified 13 studies (n = 10,438) on AKI incidence and three studies (n = 1596) on AKI progression. Elevated UACR was associated with an increased risk of AKI (pooled OR 1.39; 95% CI 1.08–1.79) and AKI progression (pooled OR 3.76; 95% CI 2.59–5.45). The pooled sensitivity and specificity for AKI prediction were 0.71 (95% CI 0.59–0.80) and 0.67 (95% CI 0.56–0.76), respectively, with an area under the curve (AUC) of 0.74. However, there was high heterogeneity across studies, and UACR thresholds for AKI prediction varied widely. Despite these limitations, UACR appears to be a promising, low-cost biomarker for predicting AKI, particularly in high-risk settings such as cardiac surgery. Standardization of thresholds and further validation are needed to support its clinical implementation.