Kidney Week

Abstract: SA-PO541

Low-Grade Albuminuria and Cardiovascular Mortality Among Healthy Adults

Session Information

• Hypertension and CVD: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Claudel, Sophie E., Boston Medical Center, Boston, Massachusetts, United States

Sophie E. Claudel,

• Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States

Sushrut S. Waikar,

• Schmidt, Insa Marie, Boston Medical Center, Boston, Massachusetts, United States

Insa Marie Schmidt,

• Ramachandran, Vasan S., Boston University School of Public Health, Boston, Massachusetts, United States

Vasan S. Ramachandran,

• Verma, Ashish, Boston Medical Center, Boston, Massachusetts, United States

Ashish Verma,

Background

Albuminuria is associated with cardiovascular events among adults with underlying cardiovascular disease and diabetes, even at low levels of urinary albumin excretion. We hypothesized that low-grade albuminuria is associated with cardiovascular death among healthy adults.

Methods

We included adults participating in the 1999-2014 National Health and Nutrition Examination Survey (N=18,696). We excluded those with urinary albumin-to-creatine ratio (UACR) >30mg/g, baseline cardiovascular disease, hypertension, diabetes, estimated glomerular filtration rate <60ml/min/1.73m², those who were currently pregnant, and those who had received dialysis in the last year. We assessed the relationship between log-transformed UACR and cardiovascular and all-cause mortality using multivariable Cox proportional hazards models. Models were adjusted for age, sex, race or ethnicity, survey year, BMI, insurance, smoking, A1c, systolic blood pressure, total cholesterol, serum albumin, statin use, and eGFR.

Results

Mean age was 38.1 years (standard deviation 14.0) and 53.4% were female. The median length of follow up was 12.2 years [interquartile range 8.4-16.4 years]. In adjusted models, each doubling of UACR was associated with a 34% higher risk of cardiovascular death [HR 1.34 (95% confidence interval (CI) 1.10-1.63)] and a 28% higher risk of all-cause mortality [HR 1.28 (95% CI 1.16-1.41)]. The highest tertile of UACR was associated with an 84% higher risk of cardiovascular death [HR 1.84 (95% CI 1.18-2.89)] and 59% higher risk of all-cause mortality [HR 1.59 (95% CI 1.29-1.97)], compared with the lowest tertile (Table 1).

Conclusion

Higher levels of albuminuria in the "normal" range < 30 mg/g in healthy individuals nevertheless predict cardiovascular and all-cause mortality.

Table 1

Funding

• Other NIH Support