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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R. Marin, P. Rodriguez, S. Tranche, J. Redon, F. Morales-Olivas, A. Galgo, M. A. Brito, J. Mediavilla, J. V. Lozano, C. Filozof, et al. Prevalence of Abnormal Urinary Albumin Excretion Rate in Hypertensive Patients with Impaired Fasting Glucose and Its Association with Cardiovascular Disease J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S178 - S188. [Abstract] [Full Text] [PDF]
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J. L. Carter, C. R. V. Tomson, P. E. Stevens, and E. J. Lamb Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3031 - 3037. [Full Text] [PDF]
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W. A.K.M. Windt, W. B.A. Eijkelkamp, R. H. Henning, A. C.A. Kluppel, P. A. de Graeff, H. L. Hillege, S. Schafer, D. de Zeeuw, and R. P.E. van Dokkum Renal Damage after Myocardial Infarction Is Prevented by Renin-Angiotensin-Aldosterone-System Intervention J. Am. Soc. Nephrol., November 1, 2006; 17(11): 3059 - 3066. [Abstract] [Full Text] [PDF]
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R. M.A. van de Wal, R. T. Gansevoort, P. van der Harst, F. Boomsma, H.W. Thijs Plokker, D. J. van Veldhuisen, P. E. de Jong, W. H. van Gilst, and A. A. Voors Predictors of Angiotensin-Converting Enzyme Inhibitor-Induced Reduction of Urinary Albumin Excretion in Nondiabetic Patients Hypertension, November 1, 2006; 48(5): 870 - 876. [Abstract] [Full Text] [PDF]
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L. M. Ruilope and J. Segura Predictors of the Evolution of Microalbuminuria Hypertension, November 1, 2006; 48(5): 832 - 833. [Full Text] [PDF]
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R. T. Gansevoort, J. Brinkman, S. J. L. Bakker, P. E. De Jong, and D. de Zeeuw Evaluation of Measures of Urinary Albumin Excretion Am. J. Epidemiol., October 15, 2006; 164(8): 725 - 727. [Abstract] [Full Text] [PDF]
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W. Lieb, B. Mayer, J. Stritzke, A. Doering, H.-W. Hense, H. Loewel, J. Erdmann, and H. Schunkert Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: The MONICA/KORA Augsburg Echocardiographic Substudy Nephrol. Dial. Transplant., October 1, 2006; 21(10): 2780 - 2787. [Abstract] [Full Text] [PDF]
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 S. E. Borggreve, H. L. Hillege, B. H. R. Wolffenbuttel, P. E. de Jong, M. W. Zuurman, G. van der Steege, A. van Tol, R. P. F. Dullaart, and on behalf of the PREVEND Study Group An Increased Coronary Risk Is Paradoxically Associated with Common Cholesteryl Ester Transfer Protein Gene Variations That Relate to Higher High-Density Lipoprotein Cholesterol: A Population-Based Study J. Clin. Endocrinol. Metab., September 1, 2006; 91(9): 3382 - 3388. [Abstract] [Full Text] [PDF]
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C. D.A. Stehouwer and Y. M. Smulders Microalbuminuria and Risk for Cardiovascular Disease: Analysis of Potential Mechanisms J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2106 - 2111. [Abstract] [Full Text] [PDF]
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D. de Zeeuw, H.-H. Parving, and R. H. Henning Microalbuminuria as an Early Marker for Cardiovascular Disease J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2100 - 2105. [Abstract] [Full Text] [PDF]
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 K. Douglas, P. G. O'Malley, and J. L. Jackson Meta-Analysis: The Effect of Statins on Albuminuria Ann Intern Med, July 18, 2006; 145(2): 117 - 124. [Abstract] [Full Text] [PDF]
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E. S. Ommen, J. A. Winston, and B. Murphy Medical Risks in Living Kidney Donors: Absence of Proof Is Not Proof of Absence Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 885 - 895. [Abstract] [Full Text] [PDF]
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M. Tonelli, P. Jose, G. Curhan, F. Sacks, E. Braunwald, M. Pfeffer, and Cholesterol and Recurrent Events (CARE) Trial Inve Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial BMJ, June 17, 2006; 332(7555): 1426. [Abstract] [Full Text] [PDF]
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 I Rietveld, A Hofman, H A P Pols, C M van Duijn, S W J Lamberts, and J A M J L Janssen An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance. Eur. J. Endocrinol., May 1, 2006; 154(5): 715 - 721. [Abstract] [Full Text] [PDF]
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 A. Tsakiris, M. Doumas, D. Lagatouras, G. Vyssoulis, E. Karpanou, N. Nearchou, C. Kouremenou, and P. Skoufas Microalbuminuria Is Determined by Systolic and Pulse Pressure Over a 12-Year Period and Related to Peripheral Artery Disease in Normotensive and Hypertensive Subjects: The Three Areas Study in Greece (TAS-GR) Angiology, May 1, 2006; 57(3): 313 - 320. [Abstract] [PDF]
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R. T. Gansevoort, S. J.L. Bakker, and P. E. de Jong Early Detection of Progressive Chronic Kidney Disease: Is It Feasible? J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1218 - 1220. [Full Text] [PDF]
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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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