Clin Rheumatol. 2026 Aug 4. doi: 10.1007/s10067-026-08343-0. Online ahead of print.
ABSTRACT
BACKGROUND: Osteoarthritis (OA) is associated with increased all-cause and cardiovascular disease (CVD) mortality, yet simple biomarkers for risk stratification are lacking. UACR, which measures the albumin-to-creatinine ratio in urine, is a known marker for kidney injury and mortality prediction in different populations, but its prognostic value in OA remains unknown.
METHODS: This prospective cohort study included 3061 US adults with OA from the National Health and Nutrition Examination Survey 2005-2018. Weighted Cox proportional hazards models, Kaplan-Meier curves, subgroup analyses, and multiple imputation sensitivity analyses were performed.
RESULTS: During a median follow-up period of 81.3 months, there were 526 deaths from all causes and 147 deaths from CVD disease. Higher UACR was associated with stepwise increased mortality (log-rank P < 0.001). For every 100 mg/g rise in UACR, the fully adjusted models showed HRs of 1.04 (95% CI 1.03-1.06) for mortality from all causes and 1.04 (1.00-1.07) for mortality due to CVD. When compared to a UACR of less than 30 mg/g, the HRs for UACR levels between 30-300 mg/g and 300 mg/g or more were 2.01 (1.54-2.63) and 4.29 (2.66-6.93) for all-cause mortality and 2.28 (1.48-3.51) and 3.84 (1.87-7.90) for CVD mortality (both P for trend < 0.001). Stronger associations were noted among females and those with lung disease (P for interaction = 0.030 and < 0.001, respectively). Sensitivity analyses confirmed robustness.
CONCLUSIONS: Elevated UACR is independently and incrementally associated with higher all-cause and CVD mortality in OA patients, especially in women and those with comorbid lung disease. UACR may function as an uncomplicated, non-invasive tool for predicting risk in OA. Key Points • First nationally representative cohort study linking UACR with mortality in osteoarthritis patients. • Elevated UACR independently predicted higher all-cause and cardiovascular mortality in a dose-response manner. • Stronger associations were found in females and those with comorbid lung disease. • UACR may serve as a simple, non-invasive tool for mortality risk stratification in osteoarthritis.
PMID:42547678 | DOI:10.1007/s10067-026-08343-0