title: Cross-classification of microalbuminuria and reduced glomerular filtration rate: associations between cardiovascular disease risk factors and clinical outcomes.
abstract: BACKGROUND
  Chronic kidney disease is defined by reduced estimated glomerular filtration rate (reduced eGFR) or by microalbuminuria (MA). Concordance between reduced eGFR and MA and associated cardiovascular disease (CVD) and all-cause mortality according to these definitions is uncertain.
  
  
  METHODS
  Participants (n = 2966 [52.6% were women], mean age, 59 years) were drawn from the Framingham Offspring Cohort. Participants were classified into 4 groups based on the presence or absence of reduced eGFR (eGFR < 59 mL/min/1.73 m(2) in women, < 64 mL/min/1.73 m(2) in men or MA (spot urinary albumin to creatinine ratio of at least 30 mg/g). Cox proportional hazard models were used to determine the combined risk of CVD events and all-cause mortality for each group.
  
  
  RESULTS
  Of the participants, 9.9% (n = 295) had reduced eGFR, and 12.2% (n = 362) had MA. Among those with reduced eGFR, 28% had MA. Those with reduced eGFR and with MA were at increased risk for combined CVD and all-cause mortality compared with those with neither condition (hazard ratio [HR] 1.7, 95% confidence interval [CI], 1.1-2.4; P = .009), whereas those with reduced eGFR and without MA and those without reduced eGFR and with MA had similar HRs (1.3 and 1.2, respectively). Those with reduced eGFR and with MA, as well as those with reduced eGFR and without MA, were at significantly increased risk of all-cause mortality (HR 2.2 [95% CI, 1.4-3.6] and HR 1.7 [95% CI, 1.1-2.6], respectively).
  
  
  CONCLUSIONS
  Reduced eGFR and MA are relatively common conditions with different risk factor profiles. The coexistence of reduced eGFR and MA was present in 2.8% of the study sample and conferred substantial increased risk for CVD and all-cause mortality, in part because of a heavy burden of CVD risk factors.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702, USA.
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Foster
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Nisha I
authors.initials: NI
authors.lastname: Parikh
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
mesh_terms: D000419:Albuminuria / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002908:Chronic Disease; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine