Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population
Introduction: A minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality, but whether it predicts kidney function loss in nondiabetic persons is unclear. We investigated the association between ACR in the optimal or high-normal range and the rate of glo...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-07-01
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| Series: | Kidney International Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024918300226 |
| _version_ | 1828802635653709824 |
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| author | Toralf Melsom Marit Dahl Solbu Jørgen Schei Vidar Tor Nyborg Stefansson Jon Viljar Norvik Trond Geir Jenssen Tom Wilsgaard Bjørn Odvar Eriksen |
| author_facet | Toralf Melsom Marit Dahl Solbu Jørgen Schei Vidar Tor Nyborg Stefansson Jon Viljar Norvik Trond Geir Jenssen Tom Wilsgaard Bjørn Odvar Eriksen |
| author_sort | Toralf Melsom |
| collection | DOAJ |
| description | Introduction: A minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality, but whether it predicts kidney function loss in nondiabetic persons is unclear. We investigated the association between ACR in the optimal or high-normal range and the rate of glomerular filtration rate (GFR) decline in a cohort from the general population without diabetes, cardiovascular, or chronic kidney disease. Methods: In the Renal Iohexol Clearance Survey, we measured GFR using iohexol clearance in 1567 middle-aged nondiabetic individuals with an ACR <3.40 mg/mmol (30.0 mg/g) at baseline. The ACR was measured in unfrozen morning urine samples collected on 3 days before the GFR measurements. A total of 1278 (81%) participants had follow-up with GFR measurements after a median of 5.6 years. Results: The median ACR at baseline was 0.22 mg/mmol (interquartile range: 0.10−0.51 mg/mmol), the mean ± SD GFR was 104.0 ± 20.1 ml/min, and the mean ± SD GFR decline rate was −0.95 ± 2.23 ml/min per year. Higher baseline ACR levels were associated with a steeper GFR decline in adjusted linear mixed models. Study participants with ACR levels of 0.11 to 0.45 and 0.46 ± 3.40 mg/mmol had a 0.25 ml/min per year (95% confidence interval [95% CI]: −0.03 to 0.53) and 0.31 ml/min per year (95% CI: 0.02−0.60) steeper rate of decline than those with ACR ≤0.10 mg/mmol in multivariable-adjusted analyses. Among study participants with an ACR of <1.13 mg/mmol (defined as the optimal range), those with an ACR of 0.11 to 1.12 mg/mmol (n = 812) had a 0.28 ml/min per year (95% CI: 0.04−0.52) steeper rate of GFR decline than those with an ACR of ≤0.10 mg/mmol (n = 655). Conclusion: A mildly increased ACR is an independent risk factor for faster GFR decline in nondiabetic individuals. Keywords: ACR, albumin-creatinine-ratio, GFR, iohexol clearance |
| first_indexed | 2024-12-12T07:07:41Z |
| format | Article |
| id | doaj.art-5524d97ab2f1485f9206fc014dac252e |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-12T07:07:41Z |
| publishDate | 2018-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-5524d97ab2f1485f9206fc014dac252e2022-12-22T00:33:42ZengElsevierKidney International Reports2468-02492018-07-0134817824Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic PopulationToralf Melsom0Marit Dahl Solbu1Jørgen Schei2Vidar Tor Nyborg Stefansson3Jon Viljar Norvik4Trond Geir Jenssen5Tom Wilsgaard6Bjørn Odvar Eriksen7Metabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Correspondence: Toralf Melsom, Section of Nephrology, University Hospital of North Norway, N-9038 Tromsø, Norway.Metabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, Department of Organ Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, NorwayDepartment of Community Medicine, UiT The Arctic University of Norway, Oslo, NorwayMetabolic and Renal Research Group, UiT The Arctic University of Norway, Oslo, Norway; Section of Nephrology, University Hospital of North Norway, Tromsø, NorwayIntroduction: A minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality, but whether it predicts kidney function loss in nondiabetic persons is unclear. We investigated the association between ACR in the optimal or high-normal range and the rate of glomerular filtration rate (GFR) decline in a cohort from the general population without diabetes, cardiovascular, or chronic kidney disease. Methods: In the Renal Iohexol Clearance Survey, we measured GFR using iohexol clearance in 1567 middle-aged nondiabetic individuals with an ACR <3.40 mg/mmol (30.0 mg/g) at baseline. The ACR was measured in unfrozen morning urine samples collected on 3 days before the GFR measurements. A total of 1278 (81%) participants had follow-up with GFR measurements after a median of 5.6 years. Results: The median ACR at baseline was 0.22 mg/mmol (interquartile range: 0.10−0.51 mg/mmol), the mean ± SD GFR was 104.0 ± 20.1 ml/min, and the mean ± SD GFR decline rate was −0.95 ± 2.23 ml/min per year. Higher baseline ACR levels were associated with a steeper GFR decline in adjusted linear mixed models. Study participants with ACR levels of 0.11 to 0.45 and 0.46 ± 3.40 mg/mmol had a 0.25 ml/min per year (95% confidence interval [95% CI]: −0.03 to 0.53) and 0.31 ml/min per year (95% CI: 0.02−0.60) steeper rate of decline than those with ACR ≤0.10 mg/mmol in multivariable-adjusted analyses. Among study participants with an ACR of <1.13 mg/mmol (defined as the optimal range), those with an ACR of 0.11 to 1.12 mg/mmol (n = 812) had a 0.28 ml/min per year (95% CI: 0.04−0.52) steeper rate of GFR decline than those with an ACR of ≤0.10 mg/mmol (n = 655). Conclusion: A mildly increased ACR is an independent risk factor for faster GFR decline in nondiabetic individuals. Keywords: ACR, albumin-creatinine-ratio, GFR, iohexol clearancehttp://www.sciencedirect.com/science/article/pii/S2468024918300226 |
| spellingShingle | Toralf Melsom Marit Dahl Solbu Jørgen Schei Vidar Tor Nyborg Stefansson Jon Viljar Norvik Trond Geir Jenssen Tom Wilsgaard Bjørn Odvar Eriksen Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population Kidney International Reports |
| title | Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population |
| title_full | Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population |
| title_fullStr | Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population |
| title_full_unstemmed | Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population |
| title_short | Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population |
| title_sort | mild albuminuria is a risk factor for faster gfr decline in the nondiabetic population |
| url | http://www.sciencedirect.com/science/article/pii/S2468024918300226 |
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