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

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58 Scopus citations


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 languageEnglish (US)
Pages (from-to)861-871
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - 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.


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

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