Circulation. 2002;106:1777-1782
Published online before print September 16, 2002, doi: 10.1161/01.CIR.0000031732.78052.81
Published online before print September 16, 2002, doi: 10.1161/01.CIR.0000031732.78052.81
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(Circulation. 2002;106:1777.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Urinary Albumin Excretion Predicts Cardiovascular and Noncardiovascular Mortality in General Population
From the Trial Coordination Center (H.L.H., W.H.v.G., D.J.v.V.), Department of Cardiology, and the Department of Internal Medicine (R.O.B.G.), Division of Nephrology (P.E.d.J.), University Hospital of Groningen, Groningen, the Netherlands; the Departments of Health Sciences (V.F.) and Clinical Pharmacology (G.F.H.D., W.H.v.G., D.d.Z.), University of Groningen, Groningen, the Netherlands; the Department of Internal Medicine (W.M.T.J.), Martini Hospital of Groningen, Groningen, the Netherlands; and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center, Utrecht, the Netherlands.
Correspondence to Prof Dr P.E. de Jong, Department of Internal Medicine, Division of Nephrology, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands. E-mail p.e.de.jong{at}int.azg.nl
Background— For the general population, the clinical relevance of an increased urinary albumin excretion rate is still debated. Therefore, we examined the relationship between urinary albumin excretion and all-cause mortality and mortality caused by cardiovascular (CV) disease and non-CV disease in the general population.
Methods and Results— In the period 1997 to 1998, all inhabitants of the city of Groningen, the Netherlands, aged between 28 and 75 years (n=85 421) were sent a postal questionnaire collecting information about risk factors for CV disease and CV morbidity and a vial to collect an early morning urine sample for measurement of urinary albumin concentration (UAC). The vital status of the cohort was subsequently obtained from the municipal register, and the cause of death was obtained from the Central Bureau of Statistics. Of these 85 421 subjects, 40 856 (47.8%) responded, and 40 548 could be included in the analysis. During a median follow-up period of 961 days (maximum 1139 days), 516 deaths with known cause were recorded. We found a positive dose-response relationship between increasing UAC and mortality. A higher UAC increased the risk of both CV and non-CV death after adjustment for other well-recognized CV risk factors, with the increase being significantly higher for CV mortality than for non-CV mortality (P=0.014). A 2-fold increase in UAC was associated with a relative risk of 1.29 for CV mortality (95% CI 1.18 to 1.40) and 1.12 (95% CI 1.04 to 1.21) for non-CV mortality.
Conclusions— Urinary albumin excretion is a predictor of all-cause mortality in the general population. The excess risk was more attributable to death from CV causes, independent of the effects of other CV risk factors, and the relationship was already apparent at levels of albuminuria currently considered to be normal.
Key Words: follow-up studies • mortality • risk factors
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J. E. Lee, Y.-G. Kim, Y.-H. Choi, W. Huh, D. J. Kim, and H. Y. Oh Serum Uric Acid Is Associated With Microalbuminuria in Prehypertension Hypertension, May 1, 2006; 47(5): 962 - 967. [Abstract] [Full Text] [PDF]
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K. Iseki Screening for renal disease--what can be learned from the Okinawa experience Nephrol. Dial. Transplant., April 1, 2006; 21(4): 839 - 843. [Full Text] [PDF]
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P. Ochodnicky, D. de Zeeuw, R. H. Henning, C. A. Kluppel, and R. P.E. van Dokkum Endothelial Function Predicts the Development of Renal Damage after Combined Nephrectomy and Myocardial Infarction J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S49 - S52. [Abstract] [Full Text] [PDF]
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J. Segura, J. A. Garcia-Donaire, M. Praga, and L. M. Ruilope Chronic Kidney Disease as a Situation of High Added Risk in Hypertensive Patients J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S136 - S140. [Abstract] [Full Text] [PDF]
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A. Morganti Randomized Clinical Trials on Surrogate End Points: Are They Useful for Evaluating Cardiovascular and Renal Disease Protection in Hypertension? The Case for Yes J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S141 - S144. [Abstract] [Full Text] [PDF]
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R. Trevisan, A. R. Dodesini, and G. Lepore Lipids and Renal Disease J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S145 - S147. [Abstract] [Full Text] [PDF]
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H. Ibsen, M. H. Olsen, K. Wachtell, K. Borch-Johnsen, L. H. Lindholm, C. E. Mogensen, B. Dahlof, S. M. Snapinn, Y. Wan, and P. A. Lyle Does Albuminuria Predict Cardiovascular Outcomes on Treatment With Losartan Versus Atenolol in Patients With Diabetes, Hypertension, and Left Ventricular Hypertrophy?: The LIFE study. Diabetes Care, March 1, 2006; 29(3): 595 - 600. [Abstract] [Full Text] [PDF]
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E. Cosson, I. Pham, P. Valensi, J. Paries, J.-R. Attali, and A. Nitenberg Impaired Coronary Endothelium-Dependent Vasodilation Is Associated With Microalbuminuria in Patients With Type 2 Diabetes and Angiographically Normal Coronary Arteries Diabetes Care, January 1, 2006; 29(1): 107 - 112. [Abstract] [Full Text] [PDF]
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 J. W. Brinkman, D. de Zeeuw, J. J. Duker, R. T. Gansevoort, I. P. Kema, H. L. Hillege, P. E. de Jong, and S. J.L. Bakker Falsely Low Urinary Albumin Concentrations after Prolonged Frozen Storage of Urine Samples Clin. Chem., November 1, 2005; 51(11): 2181 - 2183. [Full Text] [PDF]
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R. E. Schmieder, A. U. Klingbeil, E. H. Fleischmann, R. Veelken, and C. Delles Additional Antiproteinuric Effect of Ultrahigh Dose Candesartan: A Double-Blind, Randomized, Prospective Study J. Am. Soc. Nephrol., October 1, 2005; 16(10): 3038 - 3045. [Abstract] [Full Text] [PDF]
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J. Arnlov, J. C. Evans, J. B. Meigs, T. J. Wang, C. S. Fox, D. Levy, E. J. Benjamin, R. B. D'Agostino, and R. S. Vasan Low-Grade Albuminuria and Incidence of Cardiovascular Disease Events in Nonhypertensive and Nondiabetic Individuals: The Framingham Heart Study Circulation, August 16, 2005; 112(7): 969 - 975. [Abstract] [Full Text] [PDF]
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C. W, Y. PX, L. BM, C. RD, M. DL, M. RH, I. H, O. MH, W. K, B.-J. K, et al. Anorexia and Cachexia in Renal Failure--Is Leptin the Culprit?: Role of Leptin and Melanocortin Signaling in Uremia-Associated Cachexia. J Clin Invest 115: 1659-1665, 2005 J. Am. Soc. Nephrol., August 1, 2005; 16(8): 2245 - 2250. [Full Text] [PDF]
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P. A. Swift, N. D. Markandu, G. A. Sagnella, F. J. He, and G. A. MacGregor Modest Salt Reduction Reduces Blood Pressure and Urine Protein Excretion in Black Hypertensives: A Randomized Control Trial Hypertension, August 1, 2005; 46(2): 308 - 312. [Abstract] [Full Text] [PDF]
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C. A. Geluk, F. W. Asselbergs, H. L. Hillege, S. J.L. Bakker, P. E. de Jong, F. Zijlstra, and W. H. van Gilst Impact of statins in microalbuminuric subjects with the metabolic syndrome: a substudy of the PREVEND Intervention Trial Eur. Heart J., July 1, 2005; 26(13): 1314 - 1320. [Abstract] [Full Text] [PDF]
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D. de Zeeuw Albuminuria, Just a Marker for Cardiovascular Disease, Or Is It More? J. Am. Soc. Nephrol., July 1, 2005; 16(7): 1883 - 1885. [Full Text] [PDF]
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K. P. Klausen, H. Scharling, G. Jensen, and J. S. Jensen New Definition of Microalbuminuria in Hypertensive Subjects: Association With Incident Coronary Heart Disease and Death Hypertension, July 1, 2005; 46(1): 33 - 37. [Abstract] [Full Text] [PDF]
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K. R. Tuttle Renal manifestations of the metabolic syndrome Nephrol. Dial. Transplant., May 1, 2005; 20(5): 861 - 864. [Full Text] [PDF]
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F. Togel, Z. Hu, K. Weiss, J. Isaac, C. Lange, C. Westenfelder, T. Stasko, M.D. Brown, J.A. Carucci, S. Euvrard, et al. Amelioration of Acute Renal Failure by Stem Cell Therapy--Paracrine Secretion Versus Transdifferentiation into Resident Cells: Administered Mesenchymal Stem Cells Protect against Ischemic Acute Renal Failure through Differentiation-Independent Mechanisms. Am J Physiol Renal Physiol E-pub February 15, 2005 J. Am. Soc. Nephrol., May 1, 2005; 16(5): 1153 - 1163. [Full Text] [PDF]
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E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol. Dial. Transplant., March 1, 2005; 20(3): 497 - 508. [Full Text] [PDF]
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 F. W. Asselbergs, A. M. van Roon, H. L. Hillege, P. E. de Jong, R. O.B. Gans, A. J. Smit, W. H. van Gilst, and on behalf of the PREVEND IT Investigators Effects of Fosinopril and Pravastatin on Carotid Intima-Media Thickness in Subjects With Increased Albuminuria Stroke, March 1, 2005; 36(3): 649 - 653. [Abstract] [Full Text] [PDF]
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A. H. Brantsma, D. de Zeeuw, H. L. Hillege, K. Klausen, K. Borch-Johnsen, B. Feldt-Rasmussen, G. Jensen, P. Clausen, H. Scharling, M. Appleyard, et al. Letter Regarding Article by Klausen et al, "Very Low Levels of Microalbuminuria Are Associated With Increased Risk of Coronary Heart Disease and Death Independently of Renal Function, Hypertension, and Diabetes" * Response Circulation, March 1, 2005; 111(8): e110 - e111. [Full Text] [PDF]
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M. J. Krimholtz, J. Karalliedde, S. Thomas, R. Bilous, and G. Viberti Targeting Albumin Excretion Rate in the Treatment of the Hypertensive Diabetic Patient with Renal Disease J. Am. Soc. Nephrol., March 1, 2005; 16(3_suppl_1): S42 - S47. [Abstract] [Full Text] [PDF]
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