The urinary albumin‐to‐creatinine ratio can direct personalized prevention and treatment for cardiovascular and chronic kidney disease

Increased urinary albumin excretion is a strong predictor for cardiovascular events in persons with and without decreased glomerular filtration rate and can be assessed with the urinary albumin-to-creatinine ratio (UACR), which is a selective, sensitive, and convenient method for patients. As UACR levels ≥30 mg/g indicate heightened risk for cardiovascular disease (CVD) and chronic kidney disease (CKD) progression, this biomarker may be used to personalize preventive care. Among individuals with UACR ≥30 mg/g, reducing the UACR by at least 30% from the pretreatment (baseline) value is associated with a reduction in the risk for both cardiovascular and kidney events. Monitoring change in the UACR after drug treatment starts can be used to determine a need for medication adjustments, such as dose escalations, switching drug class, or adding further drug classes in patients with UACR ≥30 mg/g. In this review, we discuss how the biomarker UACR may be used to determine CVD and CKD risk, guide treatment, and monitor treatment response, and that the UACR is an effective tool to personalize medicine in patients with CKD.