Microalbuminuria is a predictor of chronic renal insufficiency in patients without diabetes and with hypertension: the MAGIC study.
OBJECTIVE
Increased urinary albumin excretion is a known risk factor for cardiovascular events and clinical nephropathy in patients with diabetes. Whether microalbuminuria predicts long-term development of chronic renal insufficiency (CRI) in patients without diabetes and with primary hypertension remains to be documented.


METHODS
We conducted an 11.8-year follow-up of 917 patients who did not have diabetes and had hypertension and were enrolled in the Microalbuminuria: A Genoa Investigation on Complications (MAGIC) cohort between 1993 and 1997. Urinary albumin-to-creatinine ratio (ACR) was assessed at baseline in untreated patients in a core laboratory. Microalbuminuria was defined as ACR > or =22 mg/g in men and ACR > or =31 mg/g in women.


RESULTS
A total of 10,268 person-years of follow-up revealed that baseline microalbuminuria was associated with an increased risk for developing CRI (relative risk [RR] 7.61; 95% confidence interval [CI] 3.19 to 8.16; P < 0.0001), cardiovascular events (composite of fatal and nonfatal cardiac and cerebrovascular events; RR 2.11; 95% CI 1.08 to 4.13; P < 0.028), and cardiorenal events (composite of former end points; RR 3.21; 95% CI 1.86 to 5.53; P < 0.0001). Microalbuminuria remained significantly related to CRI (RR 12.75; 95% CI 3.62 to 44.92; P < 0.0001) and cardiorenal events (RR 2.58; 95% CI 1.32 to 5.05; P = 0.0056) even after adjustment for several baseline covariates.


CONCLUSIONS
Microalbuminuria is an independent predictor of renal and cardiovascular complications in patients without diabetes and with primary hypertension.
Viazzi
Francesca
F
Department of Cardionephrology, University of Genoa, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
Leoncini
Giovanna
G
Conti
Novella
N
Tomolillo
Cinzia
C
Giachero
Giovanna
G
Vercelli
Marina
M
Deferrari
Giacomo
G
Pontremoli
Roberto
R
D000328:Adult; D000419:Albuminuria / Q000209:etiology* / Q000401:mortality / Q000652:urine; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000652:urine; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000652:urine; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000401:mortality / Q000652:urine; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D003404:Creatinine