Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study

David G. Warnock; Paul Muntner; Peter A. McCullough; Xiao Zhang; Leslie A. McClure; Neil Zakai; Mary Cushman; Britt B. Newsome; Reshma Kewalramani; Michael W. Steffes; George Howard; William M. McClellan

doi:10.1053/j.ajkd.2010.05.017

Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study

David G. Warnock, Paul Muntner, Peter A. McCullough, Xiao Zhang, Leslie A. McClure, Neil Zakai, Mary Cushman, Britt B. Newsome, Reshma Kewalramani, Michael W. Steffes, George Howard, William M. McClellan

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

68 Scopus citations

Abstract

Background: Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. Study Design: Prospective observational cohort study. Setting & Participants: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. Measurements & Analysis: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m²) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. Results: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m², and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. Limitations: Only 1 laboratory assessment for serum creatinine and ACR was available. Conclusions: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.

Original language	English (US)
Pages (from-to)	861-871
Number of pages	11
Journal	American Journal of Kidney Diseases
Volume	56
Issue number	5
DOIs	https://doi.org/10.1053/j.ajkd.2010.05.017
State	Published - Nov 2010

Bibliographical note

Funding Information:
Support: This research project is supported by cooperative agreement U01 NS041588 from NINDS (National Institutes of Health [NIH]), with Dr Howard as Principal Investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of NINDS or NIH. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Inc to Dr Warnock. The manuscript was sent to Amgen for internal review before submission for publication, but the company did not have any role in the design and conduct of the study or the collection, management, data analysis, or interpretation of the data.

Keywords

Estimated glomerular filtration rate
all-cause mortality
time-to-event analysis
urinary albumin-creatinine ratio

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access

10.1053/j.ajkd.2010.05.017

OpenUrl availability

Full text

Cite this

Warnock, D. G., Muntner, P., McCullough, P. A., Zhang, X., McClure, L. A., Zakai, N., Cushman, M., Newsome, B. B., Kewalramani, R., Steffes, M. W., Howard, G., & McClellan, W. M. (2010). Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. American Journal of Kidney Diseases, 56(5), 861-871. https://doi.org/10.1053/j.ajkd.2010.05.017

Warnock, DG, Muntner, P, McCullough, PA, Zhang, X, McClure, LA, Zakai, N, Cushman, M, Newsome, BB, Kewalramani, R, Steffes, MW, Howard, G & McClellan, WM 2010, 'Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study', American Journal of Kidney Diseases, vol. 56, no. 5, pp. 861-871. https://doi.org/10.1053/j.ajkd.2010.05.017

@article{ec37014869b4494f8509285f88b50dbe,

title = "Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study",

abstract = "Background: Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. Study Design: Prospective observational cohort study. Setting & Participants: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. Measurements & Analysis: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. Results: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m2, and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. Limitations: Only 1 laboratory assessment for serum creatinine and ACR was available. Conclusions: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.",

keywords = "Estimated glomerular filtration rate, all-cause mortality, time-to-event analysis, urinary albumin-creatinine ratio",

author = "Warnock, {David G.} and Paul Muntner and McCullough, {Peter A.} and Xiao Zhang and McClure, {Leslie A.} and Neil Zakai and Mary Cushman and Newsome, {Britt B.} and Reshma Kewalramani and Steffes, {Michael W.} and George Howard and McClellan, {William M.}",

note = "Funding Information: Support: This research project is supported by cooperative agreement U01 NS041588 from NINDS (National Institutes of Health [NIH]), with Dr Howard as Principal Investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of NINDS or NIH. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Inc to Dr Warnock. The manuscript was sent to Amgen for internal review before submission for publication, but the company did not have any role in the design and conduct of the study or the collection, management, data analysis, or interpretation of the data. ",

year = "2010",

month = nov,

doi = "10.1053/j.ajkd.2010.05.017",

language = "English (US)",

volume = "56",

pages = "861--871",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

number = "5",

}

TY - JOUR

T1 - Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study

AU - Warnock, David G.

AU - Muntner, Paul

AU - McCullough, Peter A.

AU - Zhang, Xiao

AU - McClure, Leslie A.

AU - Zakai, Neil

AU - Cushman, Mary

AU - Newsome, Britt B.

AU - Kewalramani, Reshma

AU - Steffes, Michael W.

AU - Howard, George

AU - McClellan, William M.

N1 - Funding Information: Support: This research project is supported by cooperative agreement U01 NS041588 from NINDS (National Institutes of Health [NIH]), with Dr Howard as Principal Investigator. The content is solely the responsibility of the authors and does not necessarily represent the official views of NINDS or NIH. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Inc to Dr Warnock. The manuscript was sent to Amgen for internal review before submission for publication, but the company did not have any role in the design and conduct of the study or the collection, management, data analysis, or interpretation of the data.

PY - 2010/11

Y1 - 2010/11

N2 - Background: Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. Study Design: Prospective observational cohort study. Setting & Participants: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. Measurements & Analysis: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. Results: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m2, and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. Limitations: Only 1 laboratory assessment for serum creatinine and ACR was available. Conclusions: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.

AB - Background: Chronic kidney disease and albuminuria are associated with increased risk of all-cause mortality. Study Design: Prospective observational cohort study. Setting & Participants: 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor: Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome: All-cause mortality (710 deaths); median duration of follow-up, 3.6 years. Measurements & Analysis: Categories of eGFR (90 to <120, 60 to <90, 45 to <60, 30 to <45, and 15 to <30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10 to <30 mg/g or high normal, 30 to 300 mg/g or high, and >300 mg/g or very high). Cox proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin level. Results: The background all-cause mortality rate for participants with normal ACR, eGFR of 90 to <120 mL/min/1.73 m2, and no coronary heart disease was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable-adjusted HR for all-cause mortality within each eGFR category. Decreased eGFR was associated with a higher adjusted HR for all-cause mortality for participants with high-normal (P = 0.01) and high (P < 0.001) ACRs, but not those with normal or very high ACRs. Limitations: Only 1 laboratory assessment for serum creatinine and ACR was available. Conclusions: Increased albuminuria was an independent risk factor for all-cause mortality. Decreased eGFR was associated with increased mortality risk in those with high-normal and high ACRs. The mortality rate was low in the normal-ACR group and increased in the very-high-ACR group, but did not vary with eGFR in these groups.

KW - Estimated glomerular filtration rate

KW - all-cause mortality

KW - time-to-event analysis

KW - urinary albumin-creatinine ratio

UR - http://www.scopus.com/inward/record.url?scp=77958511651&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77958511651&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2010.05.017

DO - 10.1053/j.ajkd.2010.05.017

M3 - Article

C2 - 20692752

AN - SCOPUS:77958511651

SN - 0272-6386

VL - 56

SP - 861

EP - 871

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

IS - 5

ER -

Kidney function, albuminuria, and all-cause mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study

Abstract

Bibliographical note

Keywords

UN SDGs

Access

OpenUrl availability

Other files and links

Fingerprint

Cite this