title: High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria: A prospective cohort study.
abstract: BACKGROUND
  The reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated.
  
  
  METHODS
  A total of 16,759 participants aged 40 to 69 years with normal or mildly reduced eGFR (45-119 ml/min/1.73 m(2)) were enrolled and divided into six groups (group 1, eGFR: 90-119 without albuminuria; group 2, eGFR: 90-119 with albuminuria; group 3, eGFR: 60-89 without albuminuria (reference); group 4, eGFR: 60-89 with albuminuria; group 5, eGFR: 45-59 without albuminuria; group 6, eGFR: 45-59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin-creatinine ratio ≥ 30 mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis.
  
  
  RESULTS
  The highest risk of ACD (RR (95% CIs): 3.95 (2.08-7.52)), CVD (7.15 (2.25-22.7)) and NPB (3.25 (1.26-8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA1c and the highest prevalence of diabetes and metabolic syndrome.
  
  
  CONCLUSIONS
  Coexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population.
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan. Electronic address: masakio@iwate-med.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fujioka
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Kozo
authors.initials: K
authors.lastname: Tanno
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Itai
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Shinichi
authors.initials: S
authors.lastname: Omama
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onoda
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.forename: Toru
authors.initials: T
authors.lastname: Kuribayashi
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Ohta
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000401:mortality* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000401:mortality*; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007239:Infections / Q000401:mortality; D008297:Male; D024821:Metabolic Syndrome / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D016012:Poisson Distribution; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Albuminuria; Chronic kidney disease; Estimated glomerular filtration rate; Mortality