Key result
High-normal UACR is linked to ~56% higher mortality in adults with poor cardiovascular health.
Why the study?
Elevated UACR in the normal range may be linked to increased mortality, but few studies have evaluated whether cardiovascular health modifies these harmful outcomes.
Cohort (n=23,697)
High-normal UACR (<30 mg/g) is associated with a significantly increased risk of all-cause mortality, particularly in individuals with poor cardiovascular health, suggesting the need for early kidney dysfunction risk management.
High-normal UACR was associated with higher mortality in poor CVH; extends observational data but leaves open whether screening or intervention alters outcomes.
Importance: Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR. Objective: To investigate associations of traditionally normal UACR and CVH with all-cause mortality. Design, Setting, and Participants: This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria. Exposures: The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points). Main Outcomes and Measures: Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups. Results: The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001). Conclusions and Relevance: The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.
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Mahemuti et al. (2023) conducted a cohort in Normal urinary albumin-to-creatinine ratio (<30 mg/g) (n=23,697). High-normal urinary albumin-to-creatinine ratio (7.68 to <30 mg/g) vs. Low urinary albumin-to-creatinine ratio (<4.67 mg/g) was evaluated on All-cause mortality in poor cardiovascular health group (HR 1.56, 95% CI 1.10-2.20, p=<0.001 for interaction). High UACR within the normal range increased all-cause mortality risk by 56% (HR 1.56) in adults with poor cardiovascular health compared to those with low UACR.
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