Urinary Albumin Excretion From Spot Urine Samples Predict All-Cause and Stroke Mortality in Africans

作者：Schutte Rudolph^*; Schmieder Roland E; Huisman Hugo W; Smith Wayne; van Rooyen Johannes M; Fourie Carla M T; Kruger Ruan; Uys Lisa; Ware Lisa; Mels Catharina M C; Greeff Minrie; Kruger Iolanthe M; Schutte Aletta E

来源：American Journal of Hypertension, 2014, 27(6): 811-818.

DOI：10.1093/ajh/hpt288

• urinary albumin excretion
• spot urine sampling
• mortality
• Africans

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 mu g/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.

• 出版日期2014-6
• 单位西北大学