Publication Date:
2014-05-13
Description:
BACKGROUND Increased urinary albumin excretion reflects general vascular damage and predicts adverse cardiovascular and renal outcomes. Albuminuria can be determined from easily collected spot urine samples, especially in low-resource settings. However, no prognostic evidence exists for Africans. METHODS We followed clinical outcomes in 1,061 randomly selected non diabetic, human immunodeficiency virus (HIV)–negative Africans (mean age: 51.5 years; 62.0% women). Baseline urinary albumin-to-creatinine ratio was assessed from spot urine samples. RESULTS Over a median follow-up of 4.52 years, 132 deaths occurred, of which 47 were cardiovascular related. The urinary albumin-to-creatinine ratio averaged 6.1 μg/mg (5th to 95th percentile interval; 1.2–70.0). In multivariable-adjusted analyses, urinary albumin excretion predicted all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.07–1.48; P = 0.006), and a tendency existed for cardiovascular mortality (HR, 1.26; 95% CI, 0.97–1.63; P = 0.087), which seemed to be driven by fatal stroke (HR, 1.72; 95% CI, 1.17–2.54; P = 0.006) rather than cardiac mortality (HR, 0.67; 95% CI, 0.41–1.07; P = 0.094). The predictive value remained in 528 hypertensives for both all-cause (HR, 1.38; 95% CI, 1.13–1.69; P = 0.001) and cardiovascular (HR, 1.45; 95% CI, 1.07–1.96; P = 0.017) mortality, again driven by stroke. Our findings also remained significant after we excluded participants with macroalbuminuria, those on antihypertensive treatment, as well as participants who died within 1 year after enrollment. CONCLUSION In nondiabetic HIV-negative Africans, albuminuria predicts all-cause and stroke mortality.
Print ISSN:
0895-7061
Electronic ISSN:
1879-1905
Topics:
Medicine
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