title: Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. dwarnock@uab.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Neil
authors.initials: N
authors.lastname: Zakai
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Britt B
authors.initials: BB
authors.lastname: Newsome
authors.forename: Reshma
authors.initials: R
authors.lastname: Kewalramani
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
mesh_terms: 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
chemical_list: D003404:Creatinine