A national prospective study found elevated urinary albumin excretion, as measured by the albumin-to-creatinine ratio, was independently associated with a 53% increase in all-cause and cardiovascular mortality in patients with rheumatoid arthritis.
Published in Frontiers in Immunology, the study analyzed data from 1,282 rheumatoid arthritis (RA) patients in the National Health and Nutrition Examination Survey (NHANES) from 2009-2018 and suggested albumin-to-creatinine ratio (ACR) may offer better prognostic value than estimated glomerular filtration rate (eGFR).
RA patients with microalbuminuria had a 53% increase in all-cause mortality compared to those with normal ACR. Macroalbuminuria was associated with a 2.62-fold increase in all-cause mortality and a 5.67-fold increase in cardiovascular mortality. Additionally, ACR was more effective than eGFR in predicting both all-cause and cardiovascular mortality at 10 years.
The study cohort was predominantly female, with 58.50% aged 60 years or older. Participants were grouped by ACR into normal (<30 mg/g), microalbuminuria (30-300 mg/g), and macroalbuminuria (≥300 mg/g) categories.
The study's limitations include potential recall bias due to the self-reported nature of RA diagnosis, lack of detailed data on RA-specific antibodies, and a relatively small number of cardiovascular deaths. The authors recommend larger, prospective cohort studies with more detailed clinical characteristics to validate these findings.
The authors declared having no competing interests.