The urine albumin-creatinine ratio is a predictor for incident long-term care in a general population

PLoS One. 2018 Mar 28;13(3):e0195013. doi: 10.1371/journal.pone.0195013. eCollection 2018.


Background: Several types of cardiovascular diseases (CVDs) impair the physical and mental status. The purpose of this study was to assess the predictive ability of several cardiovascular biomarkers for identifying the incidence of disability as future recipients of public long-term care (LTC) service.

Methods: The subjects of this study were community-dwelling elderly individuals ≥ 65 years of age without a history of CVD (n = 5,755; mean age, 71 years). The endpoint of this study was official certification as a recipient of LTC. The cohort was divided into quartiles (Qs) based on the levels of three CVD biomarkers: the urinary albumin-creatinine ratio (UACR), plasma B-type natriuretic peptide concentration (BNP), and serum high-sensitivity C-reactive protein concentration (hsCRP). A time-dependent Cox proportional hazard model was used to determine the multi-adjusted relative hazard ratios (HRs) for incident LTC among the quartiles of each biomarker.

Results: During the follow-up (mean 5.6 years), 710 subjects were authorized as recipients of LTC. The HR was only significantly increased in the higher Qs of UACR (Q3, p < 0.01; Q4, p < 0.001). However, other biomarkers were not significantly associated with the endpoint. The risk predictive performance for the incidence of LTC as evaluated by an essential model (i.e. age- and sex-adjusted) was significantly improved by incorporating the UACR (net reclassification improvement = 0.084, p < 0.01; integrated discrimination improvement = 0.0018, p < 0.01).

Conclusions: These results suggest that an increased UACR is useful for predicting physical and cognitive dysfunction in an elderly general population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albumins / analysis*
  • Biomarkers / analysis*
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / urine
  • Cohort Studies
  • Creatinine / urine*
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Long-Term Care
  • Male
  • Risk Factors
  • Urinalysis / methods*


  • Albumins
  • Biomarkers
  • Creatinine

Grant support

This study was supported in part by grants-in-aid from the scientific research funds of the Ministry of Education, Science, and Culture of Japan (Nos. 26461082 and 17K09520), Tokyo, Japan and the Japan Arteriosclerosis Prevention Fund (JAPF), Tokyo, Japan to MN. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.