Changes in Albuminuria Predict Mortality and Morbidity in... : Journal of the American Society of Nephrology (original) (raw)

Clinical Research

Changes in Albuminuria Predict Mortality and Morbidity in Patients with Vascular Disease

Schmieder, Roland E.*; Mann, Johannes F. E.†; Schumacher, Helmut‡; Gao, Peggy§; Mancia, Giuseppe‖; Weber, Michael A.¶; McQueen, Matthew**; Koon, Teo**; Yusuf, Salim** on behalf of the ONTARGET Investigators

*Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany;

†Schwabing General Hospital, and KfH Kidney Center, Ludwig Maximilians University, Munich, Germany;

‡Boehringer Ingelheim, Ingelheim, Germany;

§Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;

‖Clinica Medica, University of Milan-Bicoca, S. Gerardo Hospital, Monza, Italy;

¶Cardiology Division, State University of New York Downstate College of Medicine, Brooklyn, New York; and

**Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

Correspondence: Dr. Roland E. Schmieder, PHRI Office, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. Phone: 09131 85–36245; Fax: 09131 85-39209; E-mail: [email protected]

Received September 28, 2010

Accepted March 15, 2011

Abstract

The degree of albuminuria predicts cardiovascular and renal outcomes, but it is not known whether changes in albuminuria also predict similar outcomes. In two multicenter, multinational, prospective observational studies, a central laboratory measured albuminuria in 23,480 patients with vascular disease or high-risk diabetes. We quantified the association between a greater than or equal to twofold change in albuminuria in spot urine from baseline to 2 years and the incidence of cardiovascular and renal outcomes and all-cause mortality during the subsequent 32 months. A greater than or equal to twofold increase in albuminuria from baseline to 2 years, observed in 28%, associated with nearly 50% higher mortality (HR 1.48; 95% CI 1.32 to 1.66), and a greater than or equal to twofold decrease in albuminuria, observed in 21%, associated with 15% lower mortality (HR 0.85; 95% CI 0.74 to 0.98) compared with those with lesser changes in albuminuria, after adjustment for baseline albuminuria, BP, and other potential confounders. Increases in albuminuria also significantly associated with cardiovascular death, composite cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure), and renal outcomes including dialysis or doubling of serum creatinine (adjusted HR 1.40; 95% CI 1.11 to 1.78). In conclusion, in patients with vascular disease, changes in albuminuria predict mortality and cardiovascular and renal outcomes, independent of baseline albuminuria. This suggests that monitoring albuminuria is a useful strategy to help predict cardiovascular risk.