BACKGROUND: Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. PREDICTOR: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). OUTCOME: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. MEASUREMENTS & ANALYSIS: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m(2)) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. RESULTS: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m(2), and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. LIMITATIONS: Only 1 laboratory assessment for serum creatinine and ACR was available. CONCLUSIONS: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.
BACKGROUND:Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. PREDICTOR: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). OUTCOME: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. MEASUREMENTS & ANALYSIS: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m(2)) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. RESULTS: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m(2), and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. LIMITATIONS: Only 1 laboratory assessment for serum creatinine and ACR was available. CONCLUSIONS: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.
Authors: David G Warnock; William McClellan; Leslie A McClure; Britt Newsome; Ruth C Campbell; Paul Audhya; Mary Cushman; Virginia J Howard; George Howard Journal: Kidney Int Date: 2005-10 Impact factor: 10.612
Authors: Daniel E Weiner; Sayed Tabatabai; Hocine Tighiouart; Essam Elsayed; Nisha Bansal; John Griffith; Deeb N Salem; Andrew S Levey; Mark J Sarnak Journal: Am J Kidney Dis Date: 2006-09 Impact factor: 8.860
Authors: Nynke Halbesma; Dirk-Sjoerd Kuiken; Auke H Brantsma; Stephan J L Bakker; Jack F M Wetzels; Dick De Zeeuw; Paul E De Jong; Ronald T Gansevoort Journal: J Am Soc Nephrol Date: 2006-08-09 Impact factor: 10.121
Authors: Virginia J Howard; Mary Cushman; Leavonne Pulley; Camilo R Gomez; Rodney C Go; Ronald J Prineas; Andra Graham; Claudia S Moy; George Howard Journal: Neuroepidemiology Date: 2005-06-29 Impact factor: 3.282
Authors: H C Gerstein; J F Mann; Q Yi; B Zinman; S F Dinneen; B Hoogwerf; J P Hallé; J Young; A Rashkow; C Joyce; S Nawaz; S Yusuf Journal: JAMA Date: 2001-07-25 Impact factor: 56.272
Authors: Michael G Shlipak; Mark J Sarnak; Ronit Katz; Linda F Fried; Stephen L Seliger; Anne B Newman; David S Siscovick; Catherine Stehman-Breen Journal: N Engl J Med Date: 2005-05-19 Impact factor: 91.245
Authors: Michael G Shlipak; Ronit Katz; Mark J Sarnak; Linda F Fried; Anne B Newman; Catherine Stehman-Breen; Stephen L Seliger; Brian Kestenbaum; Bruce Psaty; Russell P Tracy; David S Siscovick Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: D E Weiner; M A Carpenter; A S Levey; A Ivanova; E H Cole; L Hunsicker; B L Kasiske; S J Kim; J W Kusek; A G Bostom Journal: Am J Transplant Date: 2012-05-17 Impact factor: 8.086
Authors: Manjula Kurella Tamura; Paul Muntner; Virginia Wadley; Mary Cushman; Neil A Zakai; Brian D Bradbury; Brett Kissela; Fred Unverzagt; George Howard; David Warnock; William McClellan Journal: Am J Kidney Dis Date: 2011-08-04 Impact factor: 8.860
Authors: Paul Muntner; C Barrett Bowling; Liyan Gao; Dana Rizk; Suzanne Judd; Rikki M Tanner; William McClellan; David G Warnock Journal: Clin J Am Soc Nephrol Date: 2011-07-07 Impact factor: 8.237
Authors: Carmen A Peralta; Michael G Shlipak; Suzanne Judd; Mary Cushman; William McClellan; Neil A Zakai; Monika M Safford; Xiao Zhang; Paul Muntner; David Warnock Journal: JAMA Date: 2011-04-11 Impact factor: 56.272
Authors: C Barrett Bowling; Lesley A Inker; Orlando M Gutiérrez; Richard M Allman; David G Warnock; William McClellan; Paul Muntner Journal: Clin J Am Soc Nephrol Date: 2011-10-27 Impact factor: 8.237
Authors: Rikki M Tanner; Orlando M Gutiérrez; Suzanne Judd; William McClellan; C Barrett Bowling; Brian D Bradbury; Monika M Safford; Mary Cushman; David Warnock; Paul Muntner Journal: Am J Kidney Dis Date: 2012-12-08 Impact factor: 8.860