title: Urinary albumin excretion from spot urine samples predict all-cause and stroke mortality in Africans.
abstract: BACKGROUND
  Increased urinary albumin excretion reflects general vascular damage and predicts adverse cardiovascular and renal outcomes. Albuminuria can be determined from easily collected spot urine samples, especially in low-resource settings. However, no prognostic evidence exists for Africans.
  
  
  METHODS
  We followed clinical outcomes in 1,061 randomly selected non diabetic, human immunodeficiency virus (HIV)-negative Africans (mean age: 51.5 years; 62.0% women). Baseline urinary albumin-to-creatinine ratio was assessed from spot urine samples.
  
  
  RESULTS
  Over a median follow-up of 4.52 years, 132 deaths occurred, of which 47 were cardiovascular related. The urinary albumin-to-creatinine ratio averaged 6.1 μg/mg (5th to 95th percentile interval; 1.2-70.0). In multivariable-adjusted analyses, urinary albumin excretion predicted all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.07-1.48; P = 0.006), and a tendency existed for cardiovascular mortality (HR, 1.26; 95% CI, 0.97-1.63; P = 0.087), which seemed to be driven by fatal stroke (HR, 1.72; 95% CI, 1.17-2.54; P = 0.006) rather than cardiac mortality (HR, 0.67; 95% CI, 0.41-1.07; P = 0.094). The predictive value remained in 528 hypertensives for both all-cause (HR, 1.38; 95% CI, 1.13-1.69; P = 0.001) and cardiovascular (HR, 1.45; 95% CI, 1.07-1.96; P = 0.017) mortality, again driven by stroke. Our findings also remained significant after we excluded participants with macroalbuminuria, those on antihypertensive treatment, as well as participants who died within 1 year after enrollment.
  
  
  CONCLUSIONS
  In nondiabetic HIV-negative Africans, albuminuria predicts all-cause and stroke mortality.
authors: Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa.
authors: Rudolph
authors: R
authors: Schutte
authors: Roland E
authors: RE
authors: Schmieder
authors: Hugo W
authors: HW
authors: Huisman
authors: Wayne
authors: W
authors: Smith
authors: Johannes M
authors: JM
authors: van Rooyen
authors: Carla M T
authors: CM
authors: Fourie
authors: Ruan
authors: R
authors: Kruger
authors: Lisa
authors: L
authors: Uys
authors: Lisa
authors: L
authors: Ware
authors: Catharina M C
authors: CM
authors: Mels
authors: Minrie
authors: M
authors: Greeff
authors: Iolanthé M
authors: IM
authors: Kruger
authors: Aletta E
authors: AE
authors: Schutte
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000208:ethnology / Q000401:mortality* / Q000652:urine; D015415:Biomarkers / Q000652:urine; D044383:Black People; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D000075462:Serum Albumin, Human; D013019:South Africa / Q000453:epidemiology; D020521:Stroke / Q000208:ethnology / Q000401:mortality* / Q000652:urine; D013997:Time Factors; D016482:Urinalysis
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D003404:Creatinine; D000075462:Serum Albumin, Human
keywords: Africans.; mortality; spot urine sampling; urinary albumin excretion