Albuminuria is known as a predictor of all-cause mortality and cardiovascular (CV) mortality. Thus, the importance of albuminuria has been emphasized and monitoring of albuminuria is recommended in high-risk patients, such as those with diabetes mellitus (DM) or chronic kidney disease (CKD).
In a recent study, researchers of Korea reported that low-grade albuminuria was associated with all-cause mortality and cardiovascular mortality. The study findings were published in the journal Kidney 360 on November 5, 2021.
Several previous studies showed that low-grade albuminuria was associated with all-cause mortality. However, these studies were limited to the high-risk patients such as patients with DKD and hypertension or, in the case of the old-aged participants. In addition, evidence from a large-scale population is lacking. Therefore, Jung Pyo Lee and his team conducted a study to further evaluate the association of low-grade albuminuria within the normal range with all-cause mortality and cardiovascular (CV) mortality.
It was an observational cohort study in which the researchers included 43,396 patients who participated in the National Health and Nutrition Examination Survey (1999-2016). They divided the patients into four quartiles of albumin-creatinine ratio (ACR). The major outcome assessed was all-cause mortality, and they also assessed the CV mortality. They used multivariable Cox proportional hazards models for statistical analysis.
Key Findings of the Study were:
During a median of 7.9 years follow-up, the researchers observed 3,516 (9.1%) patients died.
When compared with the reference group (Q1, ACR <4.171 mg/g), they found that low-grade albuminuria groups were associated with all-cause mortality (Q3, 6.211 ≤ ACR <10.010 mg/g, hazard ratio [HR] 1.25 ; Q4, ACR ≥10.010 mg/g, HR 1.57) in a multivariable hazards model.
They also found a similar pattern in the association of low-grade albuminuria with CV mortality.
Upon subgroup analyses, they noted that low-grade albuminuria was also associated with all-cause mortality in the nondiabetic group, non-hypertensive group, and non-chronic kidney disease group (estimated glomerular filtration rate ≥60 ml/min per 1.73 m^2).
The authors concluded, "Our findings suggest that low-grade albuminuria is associated with all-cause mortality and CV mortality. Low-grade albuminuria should be monitored even for patients with few cardiovascular risks." They further added, "In the general population, low-grade albuminuria should be carefully monitored."
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DOI: https://doi.org/10.34067/KID.0003912021