Abstract | BACKGROUND: Glomerular filtration rate and albuminuria are risk factors for cardiovascular disease and markers of renal function. OBJECTIVE: To examine the contribution of estimated glomerular filtration rate (eGFR) and urinary albumin- creatinine ratio beyond that of traditional cardiovascular risk factors to classification of patient risk for cardiovascular and renal outcomes. DESIGN: PATIENTS: 27,620 patients older than 55 years with documented cardiovascular disease, who were followed for a mean of 4.6 years. MEASUREMENTS: RESULTS: Lower eGFRs and higher urinary albumin- creatinine ratios were associated with the primary cardiovascular composite outcome (for example, an adjusted hazard ratio of 2.53 [95% CI, 1.61 to 3.99] for an eGFR <30 mL/min per 1.73 m(2) and a very high urinary albumin- creatinine ratio). However, adding information about eGFR and urinary albumin- creatinine ratio to the risk reclassification analyses led to no meaningful decrease in the proportion of patients assigned to the intermediate-risk category (31% without vs. 32% with renal information). In contrast, eGFR and urinary albumin- creatinine ratio were strongly associated with risk for long-term dialysis and greatly improved both model calibration and risk stratification capacity when added to traditional cardiovascular risk factors (65% assigned to intermediate-risk categories without renal information vs. 18% with renal information). LIMITATION: CONCLUSION: In patients with high vascular risk, eGFR and urinary albumin- creatinine ratio add little to traditional cardiovascular risk factors for stratifying cardiovascular risk but greatly improve risk stratification for renal outcomes. PRIMARY FUNDING SOURCE: Boehringer Ingelheim, Population Health Research Institute, and the European Commission.
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Authors | Catherine M Clase, Peggy Gao, Sheldon W Tobe, Matthew J McQueen, Anja Grosshennig, Koon K Teo, Salim Yusuf, Johannes F E Mann, ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in Angiotensin-Converting-Enzyme-Inhibitor Intolerant Subjects with Cardiovascular Disease) |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 154
Issue 5
Pg. 310-8
(Mar 01 2011)
ISSN: 1539-3704 [Electronic] United States |
PMID | 21357908
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Albuminuria
- Cardiovascular Diseases
(epidemiology, mortality)
- Cause of Death
- Creatinine
(urine)
- Female
- Glomerular Filtration Rate
- Humans
- Kidney
(physiopathology)
- Male
- Middle Aged
- Proportional Hazards Models
- Prospective Studies
- Risk Assessment
- Risk Factors
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