Minjung Kang1,2, Soie Kwon1,2, Jeonghwan Lee2,3, Jung-Im Shin4,5, Yong Chul Kim1,2, Jae Yoon Park6,7, Eunjin Bae8,9, Eun Young Kim10,11, Dong Ki Kim1,2, Chun Soo Lim2,3, Jung Pyo Lee2,3. 1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 5. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. 6. Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. 7. Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea. 8. Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea. 9. Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea. 10. Mental Health Center, Seoul National University Health Care Center, Seoul, Korea. 11. Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea.
Abstract
Background: Despite interest in low-grade albuminuria and poor clinical outcomes, evidence from a large-scale population is lacking. Therefore, we identified the association of low-grade albuminuria within the normal range with all-cause and cardiovascular (CV) mortality. Methods: After excluding individuals with urine albumin-creatinine ratio (ACR) ≥30 mg/g (n=6094), this cohort study analyzed 43,396 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Participants were divided into four quartiles of ACR. The primary outcome was all-cause mortality, and the secondary outcome was CV mortality. Multivariable Cox proportional hazards models were used. Results: During a median 7.9 years of follow-up, 3516 (9%) participants died. Compared with the reference group (Q1, ACR <4.171 mg/g), low-grade albuminuria groups were associated with all-cause mortality (Q3, ACR ≥6.211 to <10.010 mg/g, hazard ratio [HR], 1.25 [95% CI, 1.11 to 1.41]; Q4, ACR ≥10.010 mg/g, HR, 1.57 [95% CI, 1.41 to 1.76]) in a multivariable hazards model. A similar pattern was also seen in the association of low-grade albuminuria with CV mortality. Subgroup analyses showed that low-grade albuminuria was also associated with all-cause mortality in the nondiabetic group, nonhypertensive group, and non-CKD group (eGFR ≥60 ml/min per 1.73 m2). Conclusions: Our findings suggest that low-grade albuminuria is associated with all-cause and CV mortality. Low-grade albuminuria should be monitored, even for patients with low CV risk.
Background: Despite interest in low-grade albuminuria and poor clinical outcomes, evidence from a large-scale population is lacking. Therefore, we identified the association of low-grade albuminuria within the normal range with all-cause and cardiovascular (CV) mortality. Methods: After excluding individuals with urine albumin-creatinine ratio (ACR) ≥30 mg/g (n=6094), this cohort study analyzed 43,396 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Participants were divided into four quartiles of ACR. The primary outcome was all-cause mortality, and the secondary outcome was CV mortality. Multivariable Cox proportional hazards models were used. Results: During a median 7.9 years of follow-up, 3516 (9%) participants died. Compared with the reference group (Q1, ACR <4.171 mg/g), low-grade albuminuria groups were associated with all-cause mortality (Q3, ACR ≥6.211 to <10.010 mg/g, hazard ratio [HR], 1.25 [95% CI, 1.11 to 1.41]; Q4, ACR ≥10.010 mg/g, HR, 1.57 [95% CI, 1.41 to 1.76]) in a multivariable hazards model. A similar pattern was also seen in the association of low-grade albuminuria with CV mortality. Subgroup analyses showed that low-grade albuminuria was also associated with all-cause mortality in the nondiabetic group, nonhypertensive group, and non-CKD group (eGFR ≥60 ml/min per 1.73 m2). Conclusions: Our findings suggest that low-grade albuminuria is associated with all-cause and CV mortality. Low-grade albuminuria should be monitored, even for patients with low CV risk.
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