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American Journal of Epidemiology Advance Access published online on April 2, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn033
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Glomerular Filtration Rate, Albuminuria, and Risk of Cardiovascular and All-Cause Mortality in the US Population

Brad C. Astor1,2,3, Stein I. Hallan4,5, Edgar R. Miller, III1,2,3, Edwina Yeung1,2 and Josef Coresh1,2,3,6

1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
3 Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
4 Department of Medicine, Division of Nephrology, St. Olav University Hospital, Trondheim, Norway
5 Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
6 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Correspondence to Dr. Brad C. Astor, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205 (e-mail: bastor{at}jhsph.edu).

Received for publication March 30, 2007. Accepted for publication January 24, 2008.

Decreased glomerular filtration rate (GFR) and albuminuria are used in combination to define chronic kidney disease, but their separate and combined effects on cardiovascular and all-cause mortality have not been studied in the general population. The linked mortality file of the Third National Health and Nutrition Examination Survey includes data from 13 years of follow-up (1988–2000) for 14,586 US adults. The authors estimated GFR from standardized serum creatinine levels. Albuminuria was defined by the urinary albumin:creatinine ratio. Incidence rate ratios (IRRs) were adjusted for major cardiovascular disease risk factors and C-reactive protein. Lower estimated GFR was associated with higher risks of cardiovascular and all-cause mortality overall and within every albuminuria category. Likewise, increasing albuminuria was associated with higher risk of estimated GFR overall and within every category. When estimated GFR and albuminuria were examined simultaneously, a 10-ml/minute/1.73 m2 lower estimated GFR (among persons with estimated GFR <60 ml/minute/1.73 m2) was associated with an IRR of 1.29 (95% confidence interval: 1.06, 1.55) for cardiovascular mortality and a doubling of albuminuria was associated with an IRR of 1.06 (95% confidence interval: 1.04, 1.08) for cardiovascular mortality. The authors conclude that moderately decreased estimated GFR and albuminuria independently predict cardiovascular and all-cause mortality in the general population. These data support recent recommendations defining chronic kidney disease and stratifying subsequent risks based on both decreased GFR and albuminuria.

albuminuria; glomerular filtration rate; kidney diseases; mortality

Abbreviations: ACR, albumin:creatinine ratio; CI, confidence interval; GFR, glomerular filtration rate; ICD-10, International Classification of Diseases, Tenth Revision; MDRD, Modification of Diet in Renal Disease; NHANES III, Third National Health and Nutrition Examination Survey


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