Estimated Glomerular Filtration Rate and Albuminuria as Predictors of Outcomes in Patients With High Cardiovascular Risk A Cohort Study

被引:61
作者
Clase, Catherine M.
Gao, Peggy
Tobe, Sheldon W.
McQueen, Matthew J.
Grosshennig, Anja
Teo, Koon K.
Yusuf, Salim
Mann, Johannes F. E.
机构
[1] McMaster Univ, Hamilton, ON, Canada
[2] Populat Hlth Res Inst, Hamilton, ON, Canada
[3] Univ Toronto, Toronto, ON, Canada
[4] Schwabing Gen Hosp, Munich, Germany
[5] KfH Kidney Ctr, Munich, Germany
[6] Univ Erlangen Nurnberg, Erlangen, Germany
关键词
CHRONIC KIDNEY-DISEASE; CORONARY-HEART-DISEASE; GENERAL-POPULATION; ADVERSE OUTCOMES; ALL-CAUSE; MORTALITY; EVENTS; MICROALBUMINURIA; CLASSIFICATION; INDIVIDUALS;
D O I
10.7326/0003-4819-154-5-201103010-00005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Glomerular filtration rate and albuminuria are risk factors for cardiovascular disease and markers of renal function. Objective: To examine the contribution of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio beyond that of traditional cardiovascular risk factors to classification of patient risk for cardiovascular and renal outcomes. Design: Prospective cohort study that pooled all patients of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in Angiotensin-Converting-Enzyme-Inhibitor Intolerant Subjects with Cardiovascular Disease). Patients: 27 620 patients older than 55 years with documented cardiovascular disease, who were followed for a mean of 4.6 years. Measurements: Baseline eGFR, urinary albumin-creatinine ratio, and cardiovascular risk factors. Outcomes were all-cause mortality; a composite of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure; long-term dialysis; and a composite of long-term dialysis and doubling of serum creatinine level. Results: Lower eGFRs and higher urinary albumin-creatinine ratios were associated with the primary cardiovascular composite outcome (for example, an adjusted hazard ratio of 2.53 [95% CI, 1.61 to 3.99] for an eGFR <30 mL/min per 1.73 m(2) and a very high urinary albumin-creatinine ratio). However, adding information about eGFR and urinary albumin-creatinine ratio to the risk reclassification analyses led to no meaningful decrease in the proportion of patients assigned to the intermediate-risk category (31% without vs. 32% with renal information). In contrast, eGFR and urinary albumin-creatinine ratio were strongly associated with risk for long-term dialysis and greatly improved both model calibration and risk stratification capacity when added to traditional cardiovascular risk factors (65% assigned to intermediate-risk categories without renal information vs. 18% with renal information). Limitation: Creatinine levels were not standardized. Conclusion: In patients with high vascular risk, eGFR and urinary albumin-creatinine ratio add little to traditional cardiovascular risk factors for stratifying cardiovascular risk but greatly improve risk stratification for renal outcomes.
引用
收藏
页码:310 / 318
页数:9
相关论文
共 25 条
[1]   Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals -: The Framingham heart study [J].
Ärnlöv, J ;
Evans, JC ;
Meigs, JB ;
Wang, TJ ;
Fox, CS ;
Levy, D ;
Benjamin, EJ ;
D'Agostino, RB ;
Vasan, RS .
CIRCULATION, 2005, 112 (07) :969-975
[2]   Extended prognostic value of urinary albumin excretion for cardiovascular events [J].
Brantsma, Auke H. ;
Bakker, Stephan J. L. ;
de Zeeuw, Dick ;
de Jong, Paul E. ;
Gansevoort, Ronald T. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2008, 19 (09) :1785-1791
[3]  
*CAN ORG REPL REG, 2010, ANN REP 2008 CAN I H, P18853
[4]   Cross-classification of microalbuminuria and reduced glomerular filtration rate - Associations between cardiovascular disease risk factors and clinical outcomes [J].
Foster, Meredith C. ;
Hwang, Shih-Jen ;
Larson, Martin G. ;
Parikh, Nisha I. ;
Meigs, James B. ;
Vasan, Ramachandran S. ;
Wang, Thomas J. ;
Levy, Daniel ;
Fox, Caroline S. .
ARCHIVES OF INTERNAL MEDICINE, 2007, 167 (13) :1386-1392
[5]   Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening [J].
Halbesma, Nynke ;
Kuiken, Dirk-Sjoerd ;
Brantsma, Auke H. ;
Bakker, Stephan J. L. ;
Wetzels, Jack F. M. ;
De Zeeuw, Dick ;
De Jong, Paul E. ;
Gansevoort, Ronald T. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2006, 17 (09) :2582-2590
[6]   Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals - The HUNT II study [J].
Hallan, Stein ;
Astor, Brad ;
Romundstad, Solfrid ;
Aasarod, Knut ;
Kvenild, Kurt ;
Coresh, Josef .
ARCHIVES OF INTERNAL MEDICINE, 2007, 167 (22) :2490-2496
[7]   Combining GFR and Albuminuria to Classify CKD Improves Prediction of ESRD [J].
Hallan, Stein I. ;
Ritz, Eberhard ;
Lydersen, Stian ;
Romundstad, Solfrid ;
Kvenild, Kurt ;
Orth, Stephan R. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2009, 20 (05) :1069-1077
[8]   Relation Between Kidney Function, Proteinuria, and Adverse Outcomes [J].
Hemmelgarn, Brenda R. ;
Manns, Braden J. ;
Lloyd, Anita ;
James, Matthew T. ;
Klarenbach, Scott ;
Quinn, Robert R. ;
Wiebe, Natasha ;
Tonelli, Marcello .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 303 (05) :423-429
[9]   Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population [J].
Hillege, HL ;
Fidler, V ;
Diercks, GFH ;
van Gilst, WH ;
de Zeeuw, D ;
van Veldhuisen, DJ ;
Gans, ROB ;
Janssen, WMT ;
Grobbee, DE ;
de Jong, PE .
CIRCULATION, 2002, 106 (14) :1777-1782
[10]   The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population [J].
Irie, F ;
Iso, H ;
Sairenchi, T ;
Fukasawa, N ;
Yamagishi, K ;
Ikehara, S ;
Kanashiki, M ;
Saito, Y ;
Ota, H ;
Nose, T .
KIDNEY INTERNATIONAL, 2006, 69 (07) :1264-1271