{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T06:47:46Z","timestamp":1794552466490,"version":"4.9.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"STADAPHARM GmbH"},{"DOI":"10.13039\/501100016298","name":"European Renal Association-European Dialysis and Transplant Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016298","id-type":"DOI","asserted-by":"publisher"}]},{"name":"German Federal Ministry of Education and Research","award":["01EO0802"],"award-info":[{"award-number":["01EO0802"]}]},{"DOI":"10.13039\/501100021081","name":"European Rare Kidney Disease Reference Network","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021081","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010665","name":"Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["10116862"],"award-info":[{"award-number":["10116862"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Urinary albumin-to-creatinine ratio (UACR) and protein-to-creatinine ratio (UPCR) are established markers for risk stratification in pediatric chronic kidney disease (CKD), yet their relative strength of association with CKD progression remains unclear. We compared a head-to-head evaluation of UACR and UPCR associations with estimated glomerular filtration rate (eGFR) decline and kidney survival in a large pediatric CKD cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 596 children aged 6\u201317 years with CKD stages 3\u20134 from the 4C cohort. Baseline UACR and UPCR were log-transformed and z-standardized. CKD progression was evaluated by annual eGFR slope and a composite kidney outcome (50% eGFR loss, eGFR &amp;lt;10\u00a0mL\/min\/1.73 m\u00b2 or kidney replacement therapy). Associations per 1-SD increase were estimated using adjusted linear mixed-effect and Cox models. Differences in effect sizes were assessed using bootstrap-based bias-corrected and accelerated 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean (SD) age was 12.4 (3.3) years; 70% had congenital anomalies of the kidneys and urinary tract (CAKUT). Median (interquartile range) eGFR was 28 (14) mL\/min\/1.73 m\u00b2. Over a median follow-up of 2.5 (3.8) years, 334 events occurred. A 1-SD increase in log-UACR and log-UPCR was associated a 2.17-fold (95% CI 1.84 to 2.55) and 1.70-fold (95% CI 1.52 to 1.90) higher risk of the composite outcome, respectively; UACR showed a 28% stronger association (HRUACR\/HRUPCR = 1.28; 95% CI 1.12 to 1.53). No relative difference was found in overall eGFR slope change (slope \u2206UACR \u2013 slope \u2206UPCR = \u20130.05; 95% CI \u20130.50 to 0.24), but UACR showed stronger associations in children with advanced CKD and severe proteinuria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both UACR and UPCR were independently associated with CKD progression in this pediatirc cohort. In direct comparison, UACR demonstrated stronger associations with adverse kidney outcomes, suggesting a comparatively greater prognostic signal and supporting current guideline emphasis on albuminuria for risk stratification and intervention outcome monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag061","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T12:17:20Z","timestamp":1773404240000},"page":"ii41-ii49","source":"Crossref","is-referenced-by-count":2,"title":["Association of UACR and UPCR with kidney failure: analysis of observational data in children with chronic kidney disease"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9568-4921","authenticated-orcid":false,"given":"Murunga","family":"Sheila","sequence":"first","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Heidelberg University , Heidelberg 69120 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