Key result
Higher baseline albuminuria predicts ~471% greater odds of progressive albuminuria.
Cohort (n=5,825)
No
Baseline albuminuria is the most important predictor of progressive albuminuria in the general population, suggesting that screening for baseline albuminuria is more critical than screening for cardiovascular risk factors to identify at-risk subjects.
Answers are grounded in this paper and cite their sources.
Highlights albuminuria for risk stratification in cohorts; leaves open whether screening alters progression in the general population.
BACKGROUND: Urinary albumin excretion is known to be independently associated with progression of renal and cardiovascular disease. The aim of this study was to identify predictors for progression in albuminuria in the general population. METHODS: Data were used of the first 4 screening rounds of a community-based prospective cohort study (PREVEND). Included were 5,825 subjects that at baseline had no known renal disease or macroalbuminuria. Subjects were defined as having progressive albuminuria when they belonged to the quintile of subjects with highest absolute increase in urinary albumin excretion per year and a urinary albumin excretion during the last screening in which they participated of ≥150 mg/24 h. Change in urinary albumin excretion per year was calculated as last available urinary albumin excretion minus baseline UAE divided by follow-up time. RESULTS: During 9.3 years follow-up 132 subjects had progressive albuminuria. These subjects were significantly older, more often of male gender and had a worse cardiovascular risk profile. In a multivariable model, testing baseline values, significant predictors of progressive albuminuria were male gender (OR 2.23; p<0.001), age (OR 1.03; p<0.001), BMI (OR 1.06; p = 0.02) and baseline albuminuria (OR 5.71; p<0.001). Based on these findings a risk score was made to estimate a subject's risk for progressive albuminuria. CONCLUSION: A high baseline albuminuria is by far the most important predictor of progressive albuminuria. Thus, screening for baseline albuminuria will be more important than screening for cardiovascular risk factors in order to identify subjects at risk for progressive albuminuria.
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Scheven et al. (2013) conducted a cohort in General population without known renal disease or macroalbuminuria (n=5,825). Baseline albuminuria vs. Lower baseline albuminuria was evaluated on Progressive albuminuria (quintile with highest absolute increase in UAE per year and UAE ≥150 mg/24 h at last screening) (OR 5.71, 95% CI 4.64-7.02, p=<0.001). Higher baseline albuminuria was the strongest predictor of progressive albuminuria in the general population, with an odds ratio of 5.71 for log-transformed baseline urinary albumin excretion.
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