title: Dipstick proteinuria as a predictor of all-cause and cardiovascular disease mortality in Bangladesh: A prospective cohort study.
abstract: OBJECTIVE
  Baseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality.
  
  
  METHODS
  Baseline data was collected from 2000 to 2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11-12years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam.
  
  
  RESULTS
  Baseline proteinuria of 1+ or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71-4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81-6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1+ proteinuria had a stronger risk of death, 3.49 (1.64-7.41)-fold greater, than no proteinuria. Incident 1+ proteinuria had a 1.87 (0.92-3.78)-fold greater mortality over 9-10years. Remittent proteinuria revealed no increased mortality.
  
  
  CONCLUSIONS
  Baseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1+ dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension.
authors.affiliation: Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine (Section of Pulmonary/Critical Care), Harlem Hospital affiliated with Columbia University, New York, NY, United States. Electronic address: grp4@cumc.columbia.edu.
authors.forename: Gene R
authors.initials: GR
authors.lastname: Pesola
authors.affiliation: Dept. of Health Sciences, University of Chicago, IL, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Argos
authors.affiliation: Dept. of Environmental Medicine, New York University School of Medicine, New York, NY, United States.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States.
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Rabiul
authors.initials: R
authors.lastname: Hasan
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rakibuz-Zaman
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Mahbubul
authors.initials: M
authors.lastname: Eunus
authors.affiliation: University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Golam
authors.initials: G
authors.lastname: Sarwar
authors.affiliation: Dept. of Public Health Studies, Penn State College of Medicine, Hershey, PA, United States.
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.affiliation: Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine, Columbia University, New York, NY, United States.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Health Sciences, University of Chicago, IL, United States; Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States; University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001151:Arsenic / Q000032:analysis; D001459:Bangladesh; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001151:Arsenic
keywords: Bangladesh mortality; Dipstick proteinuria and mortality; Epidemiology; Proteinuria and all-cause mortality; Proteinuria and cardiovascular disease mortality