Chronic kidney disease (CKD) and albuminuria are associated with increased risk of all-cause mortality.
Prospective observational cohort study
Setting and Participants
17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.
Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR).
All-cause mortality (710 deaths); median duration of follow-up: 3.6 years.
Measurements and Analysis
Categories of eGFR (90– <120, 60–<90, 45–<60, 30–<45, and 15–<30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10–<30 mg/g or high normal, 30–300 mg/g or high, and >300 mg/g or very high). Cox’s proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin.
The background all-cause mortality rate for participants with normal ACR, eGFR of 90–<120 mL/min/1.73 m2 and no CHD was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable adjusted hazard ratio for all-cause mortality within each eGFR category. Reduced eGFR was associated with higher adjusted hazard ratio for all-cause mortality for participants with high normal (P value = 0.01) and high (P value <0.001) ACR values, but not for those with normal or very high ACR values.
Only one laboratory assessment for serum creatinine and ACR was available
Increased albuminuria was an independent risk factor for all-cause mortality. Reduced eGFR was associated with increased mortality risk among those with high normal and high ACR. 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.