You are here

Albuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

TitleAlbuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
Publication TypeJournal Article
Year of Publication2017
AuthorsDeo, R, Khodneva, YA, Shlipak, MG, Soliman, EZ, Judd, SE, McClellan, WM, Brown, TM, J Rhodes, D, Gutiérrez, OM, Shah, SJ, Albert, CM, Safford, MM
JournalHeart Rhythm
Volume14
Issue1
Pagination65-71
Date Published2017 Jan
ISSN1556-3871
Abstract

BACKGROUND: Moderate-to-severe kidney disease increases risk for sudden cardiac death (SCD). Limited studies have evaluated how mild degrees of kidney dysfunction impact SCD risk.OBJECTIVE: The purpose of this study was to evaluate the association of albuminuria, which is one of the earliest biomarkers of kidney injury, and SCD.METHODS: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective, population-based cohort of U.S. adults. Associations between albuminuria, which is categorized using urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and SCD were assessed independently and in combination.RESULTS: After median follow-up of 6.1 years, we identified 335 SCD events. Compared to participants with ACR <15 mg/g, those with higher levels had an elevated adjusted risk of SCD (ACR 15-30 mg/g, hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.11-2.11; ACR >30 mg/g, HR 1.56, 95% CI 1.17-2.11). In contrast, compared to the group with eGFR >90 mL/min/1.73 m(2), the adjusted risk of SCD was significantly elevated only among those with eGFR <45 mL/min/1.73 m(2) (HR 1.66, 95% CI 1.06-2.58). The subgroup with eGFR <45 mL/min/1.73 m(2) (n = 1003) comprised 3.7% of REGARDS, whereas ACR 15-30 mg/g (n = 3089 [11.3%]) and ACR >30 mg/g (n = 4040 [14.8%] were far more common. In the analysis that combined ACR and eGFR categories, albuminuria consistently identified individuals with eGFR ≥60 mLmin/1.73 m(2) who were at significantly increased SCD risk.CONCLUSION: Low levels of kidney injury as measured by ACR predict an increase in SCD risk.

DOI10.1016/j.hrthm.2016.08.004
Alternate JournalHeart Rhythm
PubMed ID27523775
PubMed Central IDPMC5256547
Grant ListK23 DK089118 / DK / NIDDK NIH HHS / United States
K24 HL111154 / HL / NHLBI NIH HHS / United States
R01 HL080477 / HL / NHLBI NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States