Dena E. Rifkin, MD; Mark J. Sarnak, MD, MS
Does the combination of estimated glomerular filtration rate (EGFR) and urine albumin excretion predict cardiovascular death (CVD)?
Cohort study (second Nord-Trøndelag Health Study [HUNT II]) with a median 8.3-year follow-up.
Nord-Trøndelag County, Norway.
9709 participants ≥ 20 years (mean age 62 y, 55% women, 76% had hypertension or diabetes) who provided 3 urine samples.
EGFR (≥ 75 mL/min/1.73 m2, 60 to 74 mL/min/1.73 m2, 45 to 59 mL/min/1.73 m2, or < 45 mL/min/1.73 m2) and albuminuria (optimal urine albumin–creatinine ratio [ACR] [< 5 mg/g in men and < 7 mg/g in women], high-normal ACR [5 to 19 mg/g in men and 7 to 29 mg/g in women], or microalbuminuria [ACR 20 to 200 mg/g in men and 30 to 300 mg/g in women]). Results were adjusted for age, sex, CV disease, diabetes, systolic blood pressure, antihypertensive drugs, smoking, and total and high-density lipoprotein cholesterol.
CVD assessed from death certificates.
At a median follow-up of 8.3 years, 1981 participants died (1018 of CVD). Multivariate analysis showed a strong trend for higher risk for CVD at lower EGFR in people with microalbuminuria (P = 0.02 for those < 70 y and P = 0.002 for those < 70 y). No trend for increased risk was noted at decreasing EGFR in persons at high-normal or optimal ACR in either age group (P ≥ 0.31). Risks for different EGFR levels combined with ACRs are in the Table. Adding EGFR and albuminuria to a predictive model that included traditional risk factors increased the area under the receiver-operating characteristic curve by 0.0022 and 0.0096 in people < 70 years and ≥ 70 years, respectively.
EGFR < 45 mL/min/1.73m2 plus microalbuminuria is a strong predictor of CVD.
Interaction between estimated glomerular filtration rate (EGFR) and urine albumin–creatinine ratio (ACR) as risk factors for CVD*
*CVD = cardiovascular death; CI defined in Glossary. EGFR reported in mL/min/1.73 m2
†Adjusted for age, sex, cardiovascular disease, diabetes, systolic blood pressure, antihypertensive drugs, smoking, and total and high-density lipoprotein cholesterol.
‡ACR < 5 mg/g in men and < 7 mg/g in women.
§ACR = 5 to 19 mg/g in men and 7 to 29 mg/g in women.
||ACR = 20 to 200 mg/g in men and 30 to 300 mg/g in women.
Rifkin DE, Sarnak MJ. Glomerular filtration rate < 45 mL/min/1.73 m2 with microalbuminuria was associated with increased risk for CV death. Ann Intern Med. ;148:JC3–14. doi: 10.7326/0003-4819-148-10-200805200-02014
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Published: Ann Intern Med. 2008;148(10):JC3-14.
Nephrology, Urological Disorders.
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