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Urinary albumin-to-creatinine ratio is an attractive, unifying biomarker of cardiovascular, kidney, and metabolic conditions that may be useful for identifying and monitoring disease trajectory. However, albuminuria may develop through unique mechanisms across these distinct clinical phenotypes. This state-of-the-art review discusses the role of albuminuria in cardiovascular, kidney, and metabolic conditions; identifies potential pathways linking albuminuria to adverse outcomes; and provides practical approaches to screening and managing albuminuria for clinical cardiologists. Future research is needed to determine how broadly and how frequently to screen patients for albuminuria, whether it is cost-effective to treat low-grade albuminuria (10\u201330 mg\/g), and how to equitably offer newer antiproteinuric therapies across the spectrum of cardiovascular-kidney-metabolic diseases.<\/jats:p>","DOI":"10.1161\/circulationaha.124.071079","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T14:28:36Z","timestamp":1741616916000},"page":"716-732","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":134,"title":["Albuminuria in Cardiovascular, Kidney, and Metabolic Disorders: A State-of-the-Art Review"],"prefix":"10.1161","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7695-4674","authenticated-orcid":true,"given":"Sophie E.","family":"Claudel","sequence":"first","affiliation":[{"name":"Department of Medicine, Boston Medical Center, MA (S.E.C., A.V.)."},{"name":"Department of Medicine, Section of Nephrology, Boston University Chobanian &amp; Avedisian School of Medicine, MA (S.E.C., A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-6327","authenticated-orcid":true,"given":"Ashish","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Boston Medical Center, MA (S.E.C., A.V.)."},{"name":"Department of Medicine, Section of Nephrology, Boston University Chobanian &amp; Avedisian School of Medicine, MA (S.E.C., A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac683"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-007-0510-3"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000809"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.538132"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/M23-2814"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.17002"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60674-5"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00040-6"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfk014"},{"key":"e_1_3_3_12_2","volume-title":"Pathophysiology of Renal Disease","author":"Rose B","year":"1987","unstructured":"Rose B. 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