Urine albumin-to-creatinine ratio for early diagnosis and risk stratification of acute kidney injury in high-risk critically ill intensive care unit (ICU) patients: A prospective cohort study
Authors' conclusion
uACR modestly identified incident AKI and more strongly predicted persistent AKI.
Study context
- Population
- Adults in a mixed ICU with existing acute kidney injury (AKI) or at high risk (modified ARBOC score ≥ 3)1,010 screened
- Participants
- 203 adults
- Exposure
- Elevated urine albumin-to-creatinine ratio (uACR) vs not, for AKI prediction
- AKIn = 89
- No AKIn = 114
- Outcome
- Prevalence and prognostic value of elevated uACR (≥ 3.4 mg/mmol) for incident, progressive or persistent AKI (> 48 h) and ≥30% estimated glomerular filtration rate (eGFR) decline at discharge
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- AUC for incident AKI, uACR at Time 0
- 0.61
- AUC for incident AKI, uACR at Time 1
- 0.66
- AUC for persistent AKI, uACR at Time 0 and Time 1
- 0.68
Observational data: associations, not effects.
Further findings
Adding uACR at Time 0 to ARBOC
- Net reclassification improvement (NRI)
- 0.48
- Integrated discrimination improvement (IDI)
- 0.04
- Improved clinical net benefit
AKI duration and persistence (AKI patients)
- High uACR correlated with longer and more persistent AKI
Original publication
Urine albumin-to-creatinine ratio for early diagnosis and risk stratification of acute kidney injury in high-risk critically ill ICU patients: A prospective cohort study. J Crit Care. Published 5 February 2026. doi:10.
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