Circulation. 2002;106:1777-1782
Published online before print September 16, 2002, doi: 10.1161/01.CIR.0000031732.78052.81
Published online before print September 16, 2002, doi: 10.1161/01.CIR.0000031732.78052.81
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2002;106:1777.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Urinary Albumin Excretion Predicts Cardiovascular and Noncardiovascular Mortality in General Population
From the Trial Coordination Center (H.L.H., W.H.v.G., D.J.v.V.), Department of Cardiology, and the Department of Internal Medicine (R.O.B.G.), Division of Nephrology (P.E.d.J.), University Hospital of Groningen, Groningen, the Netherlands; the Departments of Health Sciences (V.F.) and Clinical Pharmacology (G.F.H.D., W.H.v.G., D.d.Z.), University of Groningen, Groningen, the Netherlands; the Department of Internal Medicine (W.M.T.J.), Martini Hospital of Groningen, Groningen, the Netherlands; and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center, Utrecht, the Netherlands.
Correspondence to Prof Dr P.E. de Jong, Department of Internal Medicine, Division of Nephrology, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands. E-mail p.e.de.jong{at}int.azg.nl
Background— For the general population, the clinical relevance of an increased urinary albumin excretion rate is still debated. Therefore, we examined the relationship between urinary albumin excretion and all-cause mortality and mortality caused by cardiovascular (CV) disease and non-CV disease in the general population.
Methods and Results— In the period 1997 to 1998, all inhabitants of the city of Groningen, the Netherlands, aged between 28 and 75 years (n=85 421) were sent a postal questionnaire collecting information about risk factors for CV disease and CV morbidity and a vial to collect an early morning urine sample for measurement of urinary albumin concentration (UAC). The vital status of the cohort was subsequently obtained from the municipal register, and the cause of death was obtained from the Central Bureau of Statistics. Of these 85 421 subjects, 40 856 (47.8%) responded, and 40 548 could be included in the analysis. During a median follow-up period of 961 days (maximum 1139 days), 516 deaths with known cause were recorded. We found a positive dose-response relationship between increasing UAC and mortality. A higher UAC increased the risk of both CV and non-CV death after adjustment for other well-recognized CV risk factors, with the increase being significantly higher for CV mortality than for non-CV mortality (P=0.014). A 2-fold increase in UAC was associated with a relative risk of 1.29 for CV mortality (95% CI 1.18 to 1.40) and 1.12 (95% CI 1.04 to 1.21) for non-CV mortality.
Conclusions— Urinary albumin excretion is a predictor of all-cause mortality in the general population. The excess risk was more attributable to death from CV causes, independent of the effects of other CV risk factors, and the relationship was already apparent at levels of albuminuria currently considered to be normal.
Key Words: follow-up studies • mortality • risk factors
This article has been cited by other articles:
 |
|
 |
|
  M S O'Neill, A V Diez-Roux, A H Auchincloss, T G Franklin, D R Jacobs Jr, B C Astor, J T Dvonch, and J Kaufman Airborne particulate matter exposure and urinary albumin excretion: the Multi-Ethnic Study of Atherosclerosis Occup. Environ. Med., August 1, 2008; 65(8): 534 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mimran and G. du Cailar Dietary sodium: the dark horse amongst cardiovascular and renal risk factors Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2138 - 2141. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Rademacher, M. Mauer, D. R. Jacobs Jr, B. Chavers, J. Steinke, and A. Sinaiko Albumin Excretion Rate in Normal Adolescents: Relation to Insulin Resistance and Cardiovascular Risk Factors and Comparisons to Type 1 Diabetes Mellitus Patients Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 998 - 1005. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. K. M. Windt, R. H. Henning, A. C. A. Kluppel, Y. Xu, D. de Zeeuw, and R. P. E. van Dokkum Myocardial infarction does not further impair renal damage in 5/6 nephrectomized rats Nephrol. Dial. Transplant., June 4, 2008; (2008) gfn233v2. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Ramos and K. Olden The Prevalence of Metabolic Syndrome Among US Women of Childbearing Age Am J Public Health, June 1, 2008; 98(6): 1122 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. C. Astor, S. I. Hallan, E. R. Miller III, E. Yeung, and J. Coresh Glomerular Filtration Rate, Albuminuria, and Risk of Cardiovascular and All-Cause Mortality in the US Population Am. J. Epidemiol., May 15, 2008; 167(10): 1226 - 1234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Jorgensen, I. Heuch, T. Jenssen, and B. K. Jacobsen Association of Albuminuria and Cancer Incidence J. Am. Soc. Nephrol., May 1, 2008; 19(5): 992 - 998. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Postma, C. Boersma, and R. T. Gansevoort Pharmacoeconomics in nephrology: considerations on cost-effectiveness of screening for albuminuria Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1103 - 1106. [Full Text] [PDF]
|
|
|
|
|
|
R. P. Obermayr, C. Temml, M. Knechtelsdorfer, G. Gutjahr, J. Kletzmayr, S. Heiss, A. Ponholzer, S. Madersbacher, R. Oberbauer, and R. Klauser-Braun Predictors of new-onset decline in kidney function in a general middle-european population Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1265 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. de Jong and R. T. Gansevoort Fact or fiction of the epidemic of chronic kidney disease--let us not squabble about estimated GFR only, but also focus on albuminuria Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1092 - 1095. [Full Text] [PDF]
|
|
|
|
 |
|
 B.C. Astor, S. Yi, L. Hiremath, T. Corbin, V. Pogue, B. Wilkening, G. Peterson, J. Lewis, J.P. Lash, F. Van Lente, et al. N-Terminal Prohormone Brain Natriuretic Peptide as a Predictor of Cardiovascular Disease and Mortality in Blacks With Hypertensive Kidney Disease: The African American Study of Kidney Disease and Hypertension (AASK) Circulation, April 1, 2008; 117(13): 1685 - 1692. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cirillo, M. P. Lanti, A. Menotti, M. Laurenzi, M. Mancini, A. Zanchetti, and N. G. De Santo Definition of Kidney Dysfunction as a Cardiovascular Risk Factor: Use of Urinary Albumin Excretion and Estimated Glomerular Filtration Rate Arch Intern Med, March 24, 2008; 168(6): 617 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Connolly, R. Cunningham, P. T. McNamee, I. S. Young, and A. P. Maxwell Troponin T is an independent predictor of mortality in renal transplant recipients Nephrol. Dial. Transplant., March 1, 2008; 23(3): 1019 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. de Jong, M. van der Velde, R. T. Gansevoort, and C. Zoccali Screening for Chronic Kidney Disease: Where Does Europe Go? Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 616 - 623. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Hanevold, J. S. Pollock, and G. A. Harshfield Racial Differences in Microalbumin Excretion in Healthy Adolescents Hypertension, February 1, 2008; 51(2): 334 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nguyen, C. McCulloch, P. Brakeman, A. Portale, and C.-y. Hsu Being Overweight Modifies the Association Between Cardiovascular Risk Factors and Microalbuminuria in Adolescents Pediatrics, January 1, 2008; 121(1): 37 - 45. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Solomon, J. Lin, C. G. Solomon, K. A. Jablonski, M. M. Rice, M. Steffes, M. Domanski, J. Hsia, B. J. Gersh, J. M. O. Arnold, et al. Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease Circulation, December 4, 2007; 116(23): 2687 - 2693. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Magliano, K. R. Polkinghorne, E. L.M. Barr, Q. Su, S. J. Chadban, P. Z. Zimmet, J. E. Shaw, and R. C. Atkins HPLC-Detected Albuminuria Predicts Mortality J. Am. Soc. Nephrol., December 1, 2007; 18(12): 3171 - 3176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sheehan, S.-W. Tsaih, B. L. King, C. Stanton, G. A. Churchill, B. Paigen, and K. DiPetrillo Genetic analysis of albuminuria in a cross between C57BL/6J and DBA/2J mice Am J Physiol Renal Physiol, November 1, 2007; 293(5): F1649 - F1656. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Whaley-Connell, B. S. Pavey, K. Chaudhary, G. Saab, and J. R. Sowers Review: Renin-angiotensin-aldosterone system intervention in the cardiometabolic syndrome and cardio-renal protection Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 27 - 35. [Abstract] [PDF]
|
|
|
|
|
|
M. S. MacGregor How common is early chronic kidney disease?: A Background Paper prepared for the UK Consensus Conference on Early Chronic Kidney Disease Nephrol. Dial. Transplant., September 1, 2007; 22(suppl_9): ix8 - ix18. [Full Text] [PDF]
|
|
|
|
|
|
R. T. Gansevoort, H. Lambers, and E. C. Witte Methodology of screening for albuminuria Nephrol. Dial. Transplant., August 1, 2007; 22(8): 2109 - 2111. [Full Text] [PDF]
|
|
|
|
|
|
T. H. Jafar, N. Chaturvedi, J. Hatcher, and A. S. Levey Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo-Asian population Nephrol. Dial. Transplant., August 1, 2007; 22(8): 2194 - 2200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Weiner, H. Tighiouart, E. F. Elsayed, J. L. Griffith, D. N. Salem, A. S. Levey, and M. J. Sarnak The Framingham Predictive Instrument in Chronic Kidney Disease J. Am. Coll. Cardiol., July 17, 2007; 50(3): 217 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Jorgensen, T. Jenssen, L. Ahmed, A. Bjornerem, R. Joakimsen, and B. K. Jacobsen Albuminuria and Risk of Nonvertebral Fractures Arch Intern Med, July 9, 2007; 167(13): 1379 - 1385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Schiffrin, M. L. Lipman, and J. F.E. Mann Chronic Kidney Disease: Effects on the Cardiovascular System Circulation, July 3, 2007; 116(1): 85 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ingelsson, J. Sundstrom, L. Lind, U. Riserus, A. Larsson, S. Basu, and J. Arnlov Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men Eur. Heart J., July 2, 2007; 28(14): 1739 - 1745. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nakayama, H. Metoki, H. Terawaki, T. Ohkubo, M. Kikuya, T. Sato, K. Nakayama, K. Asayama, R. Inoue, J. Hashimoto, et al. Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population--the Ohasama study Nephrol. Dial. Transplant., July 1, 2007; 22(7): 1910 - 1915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. B. Nanayakkara, C. van Guldener, P. M. ter Wee, P. G. Scheffer, F. J. van Ittersum, J. W. Twisk, T. Teerlink, W. van Dorp, and C. D. A. Stehouwer Effect of a Treatment Strategy Consisting of Pravastatin, Vitamin E, and Homocysteine Lowering on Carotid Intima-Media Thickness, Endothelial Function, and Renal Function in Patients With Mild to Moderate Chronic Kidney Disease: Results From the Anti-Oxidant Therapy in Chronic Renal Insufficiency (ATIC) Study Arch Intern Med, June 25, 2007; 167(12): 1262 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Ozsoy, W. A. van der Steeg, J. J. P. Kastelein, L. Arisz, and M. G. Koopman Dyslipidaemia as predictor of progressive renal failure and the impact of treatment with atorvastatin Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1578 - 1586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Bello, D. de Zeeuw, M. E. Nahas, A. H. Brantsma, S. J. L. Bakker, P. E. de Jong, and R. T. Gansevoort Impact of weight change on albuminuria in the general population Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1619 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Schmieder, C. Delles, A. Mimran, J. P. Fauvel, and L. M. Ruilope Impact of Telmisartan Versus Ramipril on Renal Endothelial Function in Patients With Hypertension and Type 2 Diabetes Diabetes Care, June 1, 2007; 30(6): 1351 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M.H. Hermans, R. Henry, J. M. Dekker, J. P. Kooman, P. J. Kostense, G. Nijpels, R. J. Heine, and C. D.A. Stehouwer Estimated Glomerular Filtration Rate and Urinary Albumin Excretion Are Independently Associated with Greater Arterial Stiffness: The Hoorn Study J. Am. Soc. Nephrol., June 1, 2007; 18(6): 1942 - 1952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marin, P. Rodriguez, S. Tranche, J. Redon, F. Morales-Olivas, A. Galgo, M. A. Brito, J. Mediavilla, J. V. Lozano, C. Filozof, et al. Prevalence of Abnormal Urinary Albumin Excretion Rate in Hypertensive Patients with Impaired Fasting Glucose and Its Association with Cardiovascular Disease J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S178 - S188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Carter, C. R. V. Tomson, P. E. Stevens, and E. J. Lamb Does urinary tract infection cause proteinuria or microalbuminuria? A systematic review Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3031 - 3037. [Full Text] [PDF]
|
|
|
|
|
|
W. A.K.M. Windt, W. B.A. Eijkelkamp, R. H. Henning, A. C.A. Kluppel, P. A. de Graeff, H. L. Hillege, S. Schafer, D. de Zeeuw, and R. P.E. van Dokkum Renal Damage after Myocardial Infarction Is Prevented by Renin-Angiotensin-Aldosterone-System Intervention J. Am. Soc. Nephrol., November 1, 2006; 17(11): 3059 - 3066. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M.A. van de Wal, R. T. Gansevoort, P. van der Harst, F. Boomsma, H.W. Thijs Plokker, D. J. van Veldhuisen, P. E. de Jong, W. H. van Gilst, and A. A. Voors Predictors of Angiotensin-Converting Enzyme Inhibitor-Induced Reduction of Urinary Albumin Excretion in Nondiabetic Patients Hypertension, November 1, 2006; 48(5): 870 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Ruilope and J. Segura Predictors of the Evolution of Microalbuminuria Hypertension, November 1, 2006; 48(5): 832 - 833. [Full Text] [PDF]
|
|
|
|
|
|
R. T. Gansevoort, J. Brinkman, S. J. L. Bakker, P. E. De Jong, and D. de Zeeuw Evaluation of Measures of Urinary Albumin Excretion Am. J. Epidemiol., October 15, 2006; 164(8): 725 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Lieb, B. Mayer, J. Stritzke, A. Doering, H.-W. Hense, H. Loewel, J. Erdmann, and H. Schunkert Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: The MONICA/KORA Augsburg Echocardiographic Substudy Nephrol. Dial. Transplant., October 1, 2006; 21(10): 2780 - 2787. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Borggreve, H. L. Hillege, B. H. R. Wolffenbuttel, P. E. de Jong, M. W. Zuurman, G. van der Steege, A. van Tol, R. P. F. Dullaart, and on behalf of the PREVEND Study Group An Increased Coronary Risk Is Paradoxically Associated with Common Cholesteryl Ester Transfer Protein Gene Variations That Relate to Higher High-Density Lipoprotein Cholesterol: A Population-Based Study J. Clin. Endocrinol. Metab., September 1, 2006; 91(9): 3382 - 3388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D.A. Stehouwer and Y. M. Smulders Microalbuminuria and Risk for Cardiovascular Disease: Analysis of Potential Mechanisms J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2106 - 2111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. de Zeeuw, H.-H. Parving, and R. H. Henning Microalbuminuria as an Early Marker for Cardiovascular Disease J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2100 - 2105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Douglas, P. G. O'Malley, and J. L. Jackson Meta-Analysis: The Effect of Statins on Albuminuria Ann Intern Med, July 18, 2006; 145(2): 117 - 124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Ommen, J. A. Winston, and B. Murphy Medical Risks in Living Kidney Donors: Absence of Proof Is Not Proof of Absence Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 885 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tonelli, P. Jose, G. Curhan, F. Sacks, E. Braunwald, M. Pfeffer, and Cholesterol and Recurrent Events (CARE) Trial Inve Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial BMJ, June 17, 2006; 332(7555): 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Rietveld, A Hofman, H A P Pols, C M van Duijn, S W J Lamberts, and J A M J L Janssen An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance. Eur. J. Endocrinol., May 1, 2006; 154(5): 715 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Tsakiris, M. Doumas, D. Lagatouras, G. Vyssoulis, E. Karpanou, N. Nearchou, C. Kouremenou, and P. Skoufas Microalbuminuria Is Determined by Systolic and Pulse Pressure Over a 12-Year Period and Related to Peripheral Artery Disease in Normotensive and Hypertensive Subjects: The Three Areas Study in Greece (TAS-GR) Angiology, May 1, 2006; 57(3): 313 - 320. [Abstract] [PDF]
|
|
|
|
|
|
R. T. Gansevoort, S. J.L. Bakker, and P. E. de Jong Early Detection of Progressive Chronic Kidney Disease: Is It Feasible? J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1218 - 1220. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Lee, Y.-G. Kim, Y.-H. Choi, W. Huh, D. J. Kim, and H. Y. Oh Serum Uric Acid Is Associated With Microalbuminuria in Prehypertension Hypertension, May 1, 2006; 47(5): 962 - 967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Iseki Screening for renal disease--what can be learned from the Okinawa experience Nephrol. Dial. Transplant., April 1, 2006; 21(4): 839 - 843. [Full Text] [PDF]
|
|
|
|
|
|
P. Ochodnicky, D. de Zeeuw, R. H. Henning, C. A. Kluppel, and R. P.E. van Dokkum Endothelial Function Predicts the Development of Renal Damage after Combined Nephrectomy and Myocardial Infarction J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S49 - S52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Segura, J. A. Garcia-Donaire, M. Praga, and L. M. Ruilope Chronic Kidney Disease as a Situation of High Added Risk in Hypertensive Patients J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S136 - S140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Morganti Randomized Clinical Trials on Surrogate End Points: Are They Useful for Evaluating Cardiovascular and Renal Disease Protection in Hypertension? The Case for Yes J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S141 - S144. [Abstract] [Full Text] |