Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular risk prediction, a meta-analysis concludes.

The analysis of 637 315 patients without a history of cardiovascular disease from 24 study cohorts found that the addition of estimated GFR and urinary albumin-to-creatinine ratio (ACR) significantly and independently improved the discrimination of cardiovascular outcomes beyond traditional risk factors.

The improvement was greater with urinary ACR than with estimated GFR and more evident for cardiovascular mortality and heart failure than for potential consequences of atherosclerosis such as coronary disease and stroke, the authors reported in Lancet Diabetes and Endocrinology.

The prediction improvement with kidney disease measures was more evident in individuals with diabetes or hypertension, they said.

According to an accompanying editorial a key contribution of the paper was to bring urinary ACR to the front stage for risk prediction, not long after its value as surrogate marker was questioned.

“Authors of clinical guidelines, especially those focused on prevention of cardiovascular mortality, should consider incorporating urinary ACR into algorithms for estimation of cardiovascular risk,” it concluded.