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American Journal of Epidemiology Advance Access originally published online on August 25, 2006
American Journal of Epidemiology 2006 164(8):725-727; doi:10.1093/aje/kwj271
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Evaluation of Measures of Urinary Albumin Excretion

Ronald T. Gansevoort1, Jacoline Brinkman2, Stephan J. L. Bakker2, Paul E. De Jong1 and Dick de Zeeuw2

1 Department of Nephrology, University Medical Center, Groningen, the Netherlands
2 Department of Clinical Pharmacology, University Medical Center, Groningen, the Netherlands

Correspondence to Dr. Ronald T. Gansevoort, Department of Nephrology, University Medical Center, P.O. Box 30.001, Groningen 9700 RB, the Netherlands (e-mail: R.T.Gansevoort{at}int.umcg.nl).

Albuminuria has recently drawn much attention as a valuable risk marker for cardiovascular and renal disease progression. Albuminuria can be measured and expressed in several ways: 1) in a spot morning urine sample as urinary albumin concentration (mg/liter) or albumin:creatinine ratio (mg/mmol) and 2) in a 24-hour urine collection as urinary albumin excretion (mg/24 hours). It has not yet been clarified which measure for albuminuria is preferable in clinical practice. One of the points on which a choice should be made is which measure shows the least within-person coefficient of variation. From the perspective of their work in the Prevention of Renal and Vascular Endstage Disease Intervention Trial, 1997–2001, the authors discuss several methodological issues that are important when interpreting studies on this topic. It is argued that fresh urine should be used, since freezing at –20°C results in considerable extra variability in the albumin concentration. Furthermore, it is important to use specifically collected urine samples and not portions of a 24-hour urine sample as a surrogate for a spot morning urine sample. Albuminuria follows a circadian rhythm. Consequently, values for the within-person coefficient of variation will therefore be different when they are measured in a portion of a 24-hour urine collection in comparison with a spot morning urine sample.

albumins; albuminuria; creatinine; epidemiologic methods

Abbreviations: SD, standard deviation

Editor's note: An invited commentary on this article appears on page 728, and the authors' response appears on page 731.


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Related articles in Am. J. Epidemiol.:

Invited Commentary: Evaluation of Measures of Urinary Albumin Excretion in Epidemiologic Studies
Alan R. Dyer
Am. J. Epidemiol. 2006 164: 728-730. [Extract] [FREE Full Text]  

Gansevoort et al. Respond to "Using Measures of Albumin Excretion"
Ronald T. Gansevoort, Jacoline Brinkman, Stephan J. L. Bakker, Paul E. De Jong, and Dick de Zeeuw
Am. J. Epidemiol. 2006 164: 731-732. [Extract] [FREE Full Text]  



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