title: Chronic kidney disease, cardiovascular disease and mortality: A prospective cohort study in a multi-ethnic Asian population.
abstract: BACKGROUND
  Few studies have examined the impact of chronic kidney disease (CKD) on adverse cardiovascular outcomes and deaths in Asian populations. We evaluated the associations of CKD with cardiovascular disease (CVD) and all-cause mortality in a multi-ethnic Asian population.
  
  
  METHODS
  Prospective cohort study of 7098 individuals who participated in two independent population-based studies involving Malay adults (n = 3148) and a multi-ethnic cohort of Chinese, Malay and Indian adults (n = 3950).
  
  
  METHODS
  CKD was assessed from CKD-EPI estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Incident CVD (myocardial infarction, stroke and CVD mortality) and all-cause mortality were identified by linkage with national disease/death registries.
  
  
  RESULTS
  Over a median follow-up of 4.3 years, 4.6% developed CVD and 6.1% died. Risks of both CVD and all-cause mortality increased with decreasing eGFR and increasing albuminuria (all p-trend <0.05). Adjusted hazard ratios (HR (95% confidence interval)) of CVD and all-cause mortality were: 1.54 (1.05-2.27) and 2.21 (1.67-2.92) comparing eGFR <45 vs ≥60; 2.81 (1.49-5.29) and 2.34 (1.28-4.28) comparing UACR ≥300 vs <30. The association between eGFR <60 and all-cause mortality was stronger among those with diabetes (p-interaction = 0.02). PAR of incident CVD was greater among those with UACR ≥300 (12.9%) and that of all-cause mortality greater among those with eGFR <45 (16.5%).
  
  
  CONCLUSIONS
  In multi-ethnic Asian adults, lower eGFR and higher albuminuria were independently associated with incident CVD and all-cause mortality. These findings extend previously reported similar associations in Western populations to Asians and emphasize the need for early detection of CKD and intervention to prevent adverse outcomes.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Department of Medicine, National University of Singapore, National Univerity Health System, Singapore.
authors.forename: Boon Wee
authors.initials: BW
authors.lastname: Teo
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Peng Guan
authors.initials: PG
authors.lastname: Ong
authors.affiliation: Singapore Eye Research Institute, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Cheung
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
authors.affiliation: National Registry of Diseases Office, Singapore.
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Chan Choon
authors.initials: CC
authors.lastname: Meng
authors.affiliation: School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Medicine, National University of Singapore, National Univerity Health System, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, Singapore Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore Department of Ophthalmology, National University of Singapore, Singapore charumathi.sabanayagam@seri.com.sg.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000208:ethnology; D044466:Asian People; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D002423:Cause of Death; D002681:China / Q000208:ethnology; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007194:India / Q000208:ethnology; D007668:Kidney / Q000503:physiopathology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Chronic kidney disease; albuminuria; cardiovascular disease; mortality