International Journal of Epidemiology, Volume 33, Number 1, pp. 189-198
IJE vol.33 no.1 © International Epidemiological Association 2004; all rights reserved.
Cardiovascular Disease |
Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study
1 Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
2 Medical Research Council Dunn Human Nutrition Unit, Cambridge, UK.
Correspondence: Dr Nicholas J Wareham, Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK. E-mail: njw1004{at}medschl.cam.ac.uk
Background In patients with diabetes or hypertension, raised albuminuria is independently associated with an increased risk of all mortality, cardiovascular morbidity and mortality, and renal insufficiency. The role of albuminuria in the general population is still controversial. We therefore undertook this study to examine the relationship between albuminuria and all-cause, cardiovascular disease (CVD) and non-CVD mortality in the general population.
Methods Prospective population-based cohort study of 20 911 individuals aged 40–79 years recruited in 1993–1997 for the EPIC-Norfolk Study (UK) and followed-up for an average of 6.3 years. Random spot urine specimens were collected at baseline and the albumin-to-creatinine ratio measured. Participants were categorized into normoalbuminuria, microalbuminuria, and macroalbuminuria ordered groups. At follow-up, vital status and cause of death were obtained from the UK Office for National Statistics.
Results During follow-up, 934 deaths were registered. Age-adjusted all-cause mortality rate increased significantly across categories of baseline albuminuria (5.3, 5.2, and 6.3/1000 person years (pyrs) across tertiles of normoalbuminuria, 8.7/1000 pyrs for microalbuminuria, and 18.4/1000 pyrs for macroalbuminuria, P < 0.001 for trend); CVD, 1.6, 1.7, 2.1, 4.3, 12.6/1000 pyrs (P < 0.001); and non-CVD, 3.7, 3.5, 4.2, 4.4, 5.8/1000 pyrs (P = 0.052) respectively. The multivariate hazard ratio for all-cause mortality associated with microalbuminuria was 1.48 (95% CI: 1.20, 1.79), and CVD 2.03 (95% CI: 1.55, 2.67). The association with non-CVD mortality was only significant in men.
Conclusions The significant increased risk of all-cause mortality especially from CVD associated with microalbuminuria, suggest that this may be a useful indicator in identifying those in the population at greatest absolute risk of fatal CVD events alongside conventional CVD risk factors.
Keywords Albuminuria, cardiovascular diseases, neoplasms, mortality, risk factor
Accepted 31 July 2003
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. H. Jafar, Z. Qadri, and S. Hashmi Prevalence of microalbuminuria and associated electrocardiographic abnormalities in an Indo-Asian population Nephrol. Dial. Transplant., July 1, 2009; 24(7): 2111 - 2116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Perico, R. F. Bravo, F. R. De Leon, and G. Remuzzi Screening for chronic kidney disease in emerging countries: feasibility and hurdles Nephrol. Dial. Transplant., May 1, 2009; 24(5): 1355 - 1358. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. McQueen and A. C. Don-Wauchope Requesting and Interpreting Urine Albumin Measurements in the Primary Health Care Setting Clin. Chem., October 1, 2008; 54(10): 1595 - 1597. [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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 M. R. Weir Microalbuminuria and Cardiovascular Disease Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 581 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Sarafidis and G. L. Bakris Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2366 - 2374. [Full Text] [PDF]
|
|
|
|
|
|
N. Halbesma, D.-S. Kuiken, A. H. Brantsma, S. J.L. Bakker, J. F.M. Wetzels, D. De Zeeuw, P. E. De Jong, R. T. Gansevoort, and for the PREVEND Study Group Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening J. Am. Soc. Nephrol., September 1, 2006; 17(9): 2582 - 2590. [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]
|
|
|
|
|
|
N. Khosla and G. Bakris Lessons Learned from Recent Hypertension Trials about Kidney Disease Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 229 - 235. [Full Text] [PDF]
|
|
|
|
|
|
D. de Zeeuw Albuminuria, Just a Marker for Cardiovascular Disease, Or Is It More? J. Am. Soc. Nephrol., July 1, 2005; 16(7): 1883 - 1885. [Full Text] [PDF]
|
|
|
|
 |
|
 T.-L. Wu, P.-Y. Chang, C.-C. Li, K.-C. Tsao, C.-F. Sun, and J. T. Wu Microplate ELISA for Urine Microalbumin: Reference Values and Results in Patients with Type 2 Diabetes and Cardiovascular Disease Ann. Clin. Lab. Sci., April 1, 2005; 35(2): 149 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. L. Bakris, V. Fonseca, R. E. Katholi, J. B. McGill, F. H. Messerli, R. A. Phillips, P. Raskin, J. T. Wright Jr, R. Oakes, M. A. Lukas, et al. Metabolic Effects of Carvedilol vs Metoprolol in Patients With Type 2 Diabetes Mellitus and Hypertension: A Randomized Controlled Trial JAMA, November 10, 2004; 292(18): 2227 - 2236. [Abstract] [Full Text] [PDF]
|
|