title: The combined contribution of albuminuria and glomerular filtration rate to the prediction of cardiovascular mortality in elderly men.
abstract: BACKGROUND
  Cardiovascular risk prediction is particularly important in the primary prevention of cardiovascular disease (CVD). Yet, data on whether the combined addition of albuminuria and estimated glomerular filtration rate (eGFR) improves cardiovascular risk prediction in individuals without CVD in the community is scarce.
  
  
  METHODS
  We investigated associations between urinary albumin excretion rate (UAER), cystatin C-based eGFR and cardiovascular mortality in a community-based cohort of elderly men (ULSAM study; n = 1113, mean age 71 years, 208 cardiovascular deaths, median follow-up 12.9 years) with prespecified analyses in participants without CVD (n = 649, 86 cardiovascular deaths).
  
  
  RESULTS
  Using multivariable Cox regression, higher UAER and lower eGFR were associated with increased risk for cardiovascular mortality independently of established cardiovascular risk factors in the whole sample and in men without CVD at baseline [subsample without CVD: UAER; hazard ratio (HR) per 1 SD 1.26, 95% confidence interval (CI) 1.05-1.51, P = 0.01; eGFR: HR per 1 SD 0.74, 95% CI 0.59-0.92, P = 0.007]. Analyses of model discrimination, calibration, reclassification and global fit suggested that UAER and eGFR also add relevant prognostic information beyond established cardiovascular risk factors in participants without prevalent CVD. Interestingly, established cutoffs used to diagnose microalbuminuria (UAER > 20 μg/min) and chronic kidney disease Stage 3 (eGFR < 60 mL/min/1.73 m(2)), appeared less suitable for cardiovascular risk prediction [integrated discrimination improvement (IDI) 0.006, P = 0.11], while cutoffs UAER > 6 μg/min and eGFR < 45 mL/min/1.73 m(2) significantly improved IDI (0.047, P < 0.001).
  
  
  CONCLUSIONS
  UAER and eGFR improved cardiovascular risk prediction beyond established cardiovascular risk factors, suggesting that these kidney biomarkers may be useful in predicting cardiovascular death in elderly men.
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Nerpin
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jobs
authors.forename: Magnus
authors.initials: M
authors.lastname: Jobs
authors.forename: Stein
authors.initials: S
authors.lastname: Hallan
authors.forename: Björn
authors.initials: B
authors.lastname: Zethelius
authors.forename: Lars
authors.initials: L
authors.lastname: Berglund
authors.forename: Samar
authors.initials: S
authors.lastname: Basu
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D055316:Cystatin C / Q000097:blood; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D055316:Cystatin C