title: Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study.
abstract: Chronic kidney disease (CKD) is associated with an increased cardiovascular disease mortality risk. It is, however, less clear at what point in the course from normal kidney function to CKD the association with cardiovascular disease appears. Studying the associations of estimated glomerular filtration rate (eGFR) and albuminuria with biomarkers of (subclinical) cardiac injury in a population without substantial CKD may clarify this issue.
  
  
  
  We examined the cross-sectional associations of eGFR and urinary albumin excretion (UAE) with high-sensitivity cardiac troponin (hs-cTn) T, hs-cTnI, and N-terminal probrain natriuretic-peptide (NT-proBNP) in 3103 individuals from a population-based diabetes-enriched cohort study.
  
  
  
  After adjustment for potential confounders, eGFR and UAE were associated with these biomarkers of cardiac injury, even at levels that do not fulfill the CKD criteria. For example, eGFR 60-<90 mL · min-1·(1.73 m2)-1[vs ≥90 mL · min-1· (1.73 m2)-1] was associated with a [ratio (95% CI)] 1.21 (1.17-1.26), 1.14 (1.07-1.20), and 1.19 (1.12-1.27) times higher hs-cTnT, hs-cTnI, and NT-proBNP, respectively. The association of eGFR with hs-cTnT was statistically significantly stronger than that with hs-cTnI. In addition, UAE 15-<30 mg/24 h (vs <15 mg/24 h) was associated with a 1.04 (0.98-1.10), 1.08 (1.00-1.18), and 1.07 (0.96-1.18) times higher hs-cTnT, hs-cTnI, and NT-proBNP, respectively.
  
  
  
  eGFR and albuminuria were already associated with biomarkers of (subclinical) cardiac injury at levels that do not fulfill the CKD criteria. Although reduced renal elimination may partly underlie the associations of eGFR, these findings support the concept that eGFR and albuminuria are, over their entire range, associated with cardiac injury.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, the Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
authors.forename: Remy J H
authors.initials: RJ
authors.lastname: Martens
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center+, Maastricht, the Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
authors.forename: Dorien M
authors.initials: DM
authors.lastname: Kimenai
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, the Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands.
authors.forename: Frans E S
authors.initials: FE
authors.lastname: Tan
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center+, Maastricht, the Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Bekers
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.|Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Carla J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, the Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
authors.forename: Karel M L
authors.initials: KM
authors.lastname: Leunissen
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Simone J S
authors.initials: SJ
authors.lastname: Sep
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.|Heart and Vascular Centre, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
authors.affiliation: Department of Clinical Chemistry and Laboratory Hematology, Gelre Ziekenhuizen, Apeldoorn/Zutphen, the Netherlands.
authors.forename: Jeroen D
authors.initials: JD
authors.lastname: van Suijlen
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center+, Maastricht, the Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
authors.forename: Marja P
authors.initials: MP
authors.lastname: van Dieijen-Visser
authors.affiliation: Department of Clinical Chemistry, Maastricht University Medical Center+, Maastricht, the Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
authors.forename: Steven J R
authors.initials: SJ
authors.lastname: Meex
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; rma.henry@mumc.nl.|Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.|Heart and Vascular Centre, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Ronald M A
authors.initials: RM
authors.lastname: Henry
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006335:Heart Injuries / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood*
chemical_list: D015415:Biomarkers