Very low-grade albuminuria is linked to arterial stiffness in a population-based cohort.

Background: Albuminuria even at low levels and increased arterial stiffness are associated with higher cardiovascular risk. Very low-grade albuminuria (VLGA; urinary albumin-creatinine ratio [uACR] <30 mg/g) has been linked to adverse outcomes, but its association with arterial stiffness in the general population, particularly among individuals without major cardiometabolic disease, remains uncertain. Methods: We analyzed data from 7613 participants of the German National Cohort (NAKO) with available uACR and brachial-ankle pulse wave velocity (PWV[ba]) measurements. Multivariable linear regression was used to assess the association between log₁₀-transformed uACR and PWV(ba), adjusting for age, sex, systolic blood pressure, obesity indices, LDL-cholesterol, HbA1c, and estimated glomerular filtration rate (eGFR). A low-risk subgroup excluded participants with arterial hypertension or diabetes mellitus. Results: Among included participants, 49.6 % were female and 7100 (93.3 %) had uACR <30 mg/g. In the full cohort, a 10-fold higher uACR was associated with higher PWV(ba) by 0.10 m/s (95 % CI 0.03-0.17). Similar associations were observed in the VLGA subgroup (0.16 m/s; 95 % CI 0.07-0.25). In the low-risk VLGA subgroup ( Conclusion: Higher uACR was consistently associated with greater arterial stiffness across the full cohort and among individuals with very low-grade albuminuria, including those without arterial hypertension or diabetes mellitus.