Abstract
BackgroundIn patients with diabetes and hypertension, proteinuria is independently associated with all-cause death. However, in the general population, urinary albumin to creatinine ratio (UACR) is less used to predict all-cause mortality. When the urinary albumin to creatinine ratio is within the normal range (UACR< 30 mg/g), the clinical relevance of an increased urinary albumin excretion rate is still debated. We studied the relationship between UACR and all-cause mortality in community populations, and compared UACR groups within the normal range.MethodsThe participants were the inhabitants from the Wanshoulu community in Beijing, China. The average age is 71.48 years, and the proportion of women is 60.1%. A total of 2148 people completed random urine samples to determine the urinary albumin to creatinine ratio (UACR). The subjects were divided into three groups according to UACR: Group 1 (UACR< 10 mg/g), Group 2 (10 mg/g < UACR< 30 mg/g), Group 3 (UACR> 30 mg/g). We used Kaplan-Meier survival analysis and Cox regression model to verify the relationship between UACR and all-cause mortality.ResultsAt an average follow-up of 9.87 years (718,407.3 years), the total mortality rate were 183.4/1000. In the Cox proportional hazards model, after adjusting for possible confounders, those with normal high-value UACR (group 2) showed a higher all-cause mortality than those with normal low-value UACR (group 1) [hazard ratio (HR) 1.289, 95% confidence interval (CI) 1.002 ~ 1.659 for all-cause mortality]. Those with proteinuria (group 3) showed a higher all-cause mortality than those with normal low-value UACR (group 1) [hazard ratio (HR) 1.394, 95% confidence interval (CI) 1.020 ~ 1.905 for all-cause mortality].ConclusionUrinary albumin to creatinine ratio is an important risk factor for all-cause death in community population. Even if it is within the normal range (UACR< 30 mg/g), it occurs in people with high normal value (10 mg/g < UACR< 30 mg/g), the risk of all-cause death will also increase.
Highlights
In patients with diabetes and hypertension, proteinuria is independently associated with all-cause death
Studies have shown that high levels of urinary albumin excretion are associated with an increase in cardiovascular (CV) mortality, especially in patients with diabetes, and hypertension, as well as those with a history of cardiovascular disease, but there are few studies on the prediction of all-cause mortality in community populations [15,16,17,18,19]
In healthy people (UACR less than 30 mg/g), the urinary albumin to creatinine ratio as a risk indicator is controversial in predicting all-cause death in healthy people [20]
Summary
In patients with diabetes and hypertension, proteinuria is independently associated with all-cause death. Studies have shown that high levels of urinary albumin excretion are associated with an increase in cardiovascular (CV) mortality, especially in patients with diabetes, and hypertension, as well as those with a history of cardiovascular disease, but there are few studies on the prediction of all-cause mortality in community populations [15,16,17,18,19]. In healthy people (UACR less than 30 mg/g), the urinary albumin to creatinine ratio as a risk indicator is controversial in predicting all-cause death in healthy people [20] Their previous relationship and degree of association have not yet been studied [2, 17, 21]. In this study, we selected a relatively large cohort from the community population, followed up for 10 years, and studied the relationship between urinary albumin to creatinine ratio and all-cause mortality from multiple levels
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