Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study.
BACKGROUND
Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality.


METHODS
Prospective observational cohort study.


METHODS
17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.


METHODS
Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR).


RESULTS
All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. MEASUREMENTS & ANALYSIS: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m(2)) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level.


RESULTS
The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m(2), and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs.


CONCLUSIONS
Only 1 laboratory assessment for serum creatinine and ACR was available.


CONCLUSIONS
Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. 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.
Warnock
David G
DG
Division of Nephrology, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. dwarnock@uab.edu
Muntner
Paul
P
McCullough
Peter A
PA
Zhang
Xiao
X
McClure
Leslie A
LA
Zakai
Neil
N
Cushman
Mary
M
Newsome
Britt B
BB
Kewalramani
Reshma
R
Steffes
Michael W
MW
Howard
George
G
McClellan
William M
WM
D000368:Aged; D000419:Albuminuria / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology*; D002423:Cause of Death / Q000639:trends; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D003404:Creatinine