title: Albuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
abstract: Moderate-to-severe kidney disease increases risk for sudden cardiac death (SCD). Limited studies have evaluated how mild degrees of kidney dysfunction impact SCD risk.
  
  
  
  The purpose of this study was to evaluate the association of albuminuria, which is one of the earliest biomarkers of kidney injury, and SCD.
  
  
  
  The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective, population-based cohort of U.S. adults. Associations between albuminuria, which is categorized using urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and SCD were assessed independently and in combination.
  
  
  
  After median follow-up of 6.1 years, we identified 335 SCD events. Compared to participants with ACR <15 mg/g, those with higher levels had an elevated adjusted risk of SCD (ACR 15-30 mg/g, hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.11-2.11; ACR >30 mg/g, HR 1.56, 95% CI 1.17-2.11). In contrast, compared to the group with eGFR >90 mL/min/1.73 m2, the adjusted risk of SCD was significantly elevated only among those with eGFR <45 mL/min/1.73 m2(HR 1.66, 95% CI 1.06-2.58). The subgroup with eGFR <45 mL/min/1.73 m2(n = 1003) comprised 3.7% of REGARDS, whereas ACR 15-30 mg/g (n = 3089 [11.3%]) and ACR >30 mg/g (n = 4040 [14.8%] were far more common. In the analysis that combined ACR and eGFR categories, albuminuria consistently identified individuals with eGFR ≥60 mLmin/1.73 m2who were at significantly increased SCD risk.
  
  
  
  Low levels of kidney injury as measured by ACR predict an increase in SCD risk.
authors: Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Rajat.Deo@uphs.upenn.edu.
authors: Rajat
authors: R
authors: Deo
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Yulia A
authors: YA
authors: Khodneva
authors: Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California.
authors: Michael G
authors: MG
authors: Shlipak
authors: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina.
authors: Elsayed Z
authors: EZ
authors: Soliman
authors: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Suzanne E
authors: SE
authors: Judd
authors: Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors: William M
authors: WM
authors: McClellan
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Todd M
authors: TM
authors: Brown
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: J David
authors: JD
authors: Rhodes
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Orlando M
authors: OM
authors: Gutiérrez
authors: Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois.
authors: Sanjiv J
authors: SJ
authors: Shah
authors: Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors: Christine M
authors: CM
authors: Albert
authors: Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors: Monika M
authors: MM
authors: Safford
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D016757:Death, Sudden, Cardiac; D005260:Female; D005843:Geography; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D044469:Racial Groups; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D014481:United States
chemical_list: D003404:Creatinine
keywords: Albuminuria; Kidney function; Population health; Risk factor; Sudden cardiac death