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High-normal albuminuria and risk of heart failure in the community.

TitleHigh-normal albuminuria and risk of heart failure in the community.
Publication TypeJournal Article
Year of Publication2011
AuthorsBlecker S, Matsushita K, Köttgen A, Loehr LR, Bertoni AG, Boulware EL, Coresh J
JournalAm J Kidney Dis
Volume58
Issue1
Pagination47-55
Date Published2011 Jul
ISSN1523-6838
KeywordsAged, Albuminuria, Creatinine, Female, Glomerular Filtration Rate, Heart Failure, Humans, Incidence, Kaplan-Meier Estimate, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors
Abstract

BACKGROUND: Albuminuria has been associated with cardiovascular risk, but the relationship of high-normal albuminuria to subsequent heart failure has not been well established.

STUDY DESIGN: Prospective observational study, the Atherosclerosis Risk in Communities (ARIC) Study.

SETTING & PARTICIPANTS: 10,975 individuals free from heart failure were followed up from the fourth ARIC Study visit (1996-1998) through January 2006.

PREDICTOR: Urinary albumin-creatinine ratio (UACR), analyzed continuously and categorically as optimal (

OUTCOMES & MEASUREMENTS: Incident heart failure was defined as a heart failure-related hospitalization or death. Cox proportional hazard models were used to calculate the HR of heart failure after adjustment for age, race, sex, estimated glomerular filtration rate (eGFR), and other cardiovascular risk factors.

RESULTS: Individuals were followed up for a median of 8.3 years and experienced 344 heart failure events. Compared with normal UACR, albuminuria was associated with a progressively increased risk of heart failure from intermediate-normal (adjusted HR, 1.54; 95% CI, 1.12-2.11) and high-normal UACR (adjusted HR, 1.91; 95% CI, 1.38-2.66) to microalbuminuria (adjusted HR, 2.49; 95% CI, 1.77-3.50) and macroalbuminuria (adjusted HR, 3.47; 95% CI, 2.10-5.72). Results were similar in secondary analyses of participants censored at the time of coronary heart disease event and along a range of eGFRs.

LIMITATIONS: UACR was measured as a single random sample.

CONCLUSIONS: Albuminuria is associated with subsequent heart failure, even in individuals with few cardiovascular risk factors and UACR within the normal range. Our results suggest that the association between albuminuria and heart failure may not be mediated fully by ischemic heart disease or kidney disease, measured using eGFR.

DOI10.1053/j.ajkd.2011.02.391
Alternate JournalAm J Kidney Dis
PubMed ID21549463
PubMed Central IDPMC3119712
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
T32 HL007024 / HL / NHLBI NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
5T32HL007024 / HL / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
K08 HS023683 / HS / AHRQ HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
T32 HL007024-38 / HL / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States