Table 1

Albuminuria: biomarker use and major limitations

Biomarker useMajor limitations
DKDNot sensitive
 Higher albuminuria levels associate with faster eGFR decline • Low eGFR present in half or more without increased  albuminuria
 Discordance between lowering albuminuria by treatment  and clinical events
CVDNonstandardized measurement and reporting
 Independently predicts events and mortality • Assays vary by ∼40%
 • Variably reported as concentration, ratio to creatinine, or timed excretion
Individual variability is large
 • Day-to-day variability ∼40%
 • Episodic increases with fever, urinary tract infection, exercise, congestive heart failure, hypertension, hyperglycemia, high-protein diet
Categorical nomenclature does not reflect continuous  nature of association with DKD and CVD risks
 • Moderately increased albuminuria (“microalbuminuria”)
 • Severely increased albuminuria (“macroalbuminuria”)