Document Detail


Associations among estimated glomerular filtration rate, proteinuria, and adverse cardiovascular outcomes.
MedLine Citation:
PMID:  21527648     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Most studies of chronic kidney disease (CKD) and outcomes focus on mortality and ESRD, with limited data on other adverse outcomes. This study examined the associations among proteinuria, eGFR, and adverse cardiovascular (CV) events.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based longitudinal study with patients identified from province-wide laboratory data from Alberta, Canada, between 2002 and 2007. Selected for this study from a total of 1,526,437 patients were 920,985 (60.3%) patients with at least one urine dipstick measurement and 102,701 patients (6.7%) with at least one albumin-creatinine ratio (ACR) measurement. Time to hospitalization was considered for one of four indications: congestive heart failure (CHF), coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), peripheral vascular disease (PVD), and stroke/transient ischemic attacks [TIAs] (cerebrovascular accident [CVA]/TIA).
RESULTS: After a median follow-up of 35 months, in fully adjusted models and compared with patients with estimated GFR (eGFR) of 45 to 59 ml/min per 1.73 m(2) and no proteinuria, patients with heavy proteinuria by dipstick and eGFR ≥ 60 ml/min per 1.73 m(2) had higher rates of CABG/PCI and CVA/TIA. Similar results were obtained in patients with proteinuria measured by ACR.
CONCLUSIONS: Risks of major CV events at a given level of eGFR increased with higher levels of proteinuria. The findings extend current data on risk of mortality and ESRD. Measurement of proteinuria is of incremental prognostic benefit at every level of eGFR. The data support use of proteinuria measurement with eGFR for definition and risk stratification in CKD.
Authors:
Aminu K Bello; Brenda Hemmelgarn; Anita Lloyd; Matthew T James; Braden J Manns; Scott Klarenbach; Marcello Tonelli;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-28
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-09     Completed Date:  2011-09-30     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1418-26     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Alberta / epidemiology
Angioplasty, Balloon, Coronary / statistics & numerical data
Biological Markers / blood
Cardiovascular Diseases / epidemiology*,  therapy
Chronic Disease
Coronary Artery Bypass / statistics & numerical data
Creatinine / blood
Female
Glomerular Filtration Rate*
Heart Failure / epidemiology
Hospitalization / statistics & numerical data
Humans
Ischemic Attack, Transient / epidemiology
Kidney / physiopathology*
Kidney Diseases / diagnosis,  epidemiology*,  physiopathology
Longitudinal Studies
Male
Middle Aged
Peripheral Arterial Disease / epidemiology
Proteinuria / diagnosis,  epidemiology*,  physiopathology
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke / epidemiology
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers; 60-27-5/Creatinine
Comments/Corrections
Comment In:
Clin J Am Soc Nephrol. 2011 Jun;6(6):1235-7   [PMID:  21597027 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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