The Association between Changes in Urinary Albumin-to-Creatinine Ratio and Risk of Abnormal Ankle-Brachial Index in a Community-Based Chinese Population

Aims: To investigate the prospective association between changes in the urinary albumin-creatinine ratio (ACR) and abnormal ankle-brachial index (ABI) in a community-based Chinese population. Methods: This prospective cohort study included 799 residents aged 58.3 +/- 9.2 years and without a history of cardiovascular disease from an urban district of Beijing, China. Urinary ACR was measured at baseline, and at 4 and 6 years of follow-up. The 75th percentile of the baseline urinary ACR (5.82 mg/g) was used to define "high" ACR. The changes in urinary ACR were categorized as consistently low urinary ACR, intermittent high urinary ACR, and consistently high urinary ACR. ABI was measured at 6 years of follow-up. Multinomial logistic regression was used to evaluate the associations of changes in urinary ACR categories with the ABI categories. Results: During 6 years of follow-up, 16.1% of participants (n = 128) had low ABI and 13.9% of participants (n = 111) had high ABI. After adjusting for potential confounders including baseline albuminuria, individuals who had consistently high urinary ACR or intermittent high urinary ACR had a significantly higher risk for low ABI than individuals who had consistently low urinary ACR, with odds ratios (OR) of 2.75 (95% CI, 1.37-5.52) and 2.06 (95% CI, 1.18-3.57), respectively. No independent association was observed between changes in urinary ACR and high ABI among participants. Conclusion: Changes in urinary ACR below the definition for albuminuria predict low ABI among this community-based population without a history of cardiovascular disease.