Albuminuria, Lung Function Decline, and Risk of Incident Chronic Obstructive Pulmonary Disease. The NHLBI Pooled Cohorts Study.

Abstract

RATIONALE:

Chronic lower respiratory diseases (CLRDs), including chronic obstructive pulmonary disease (COPD) and asthma, are the fourth leading cause of death. Prior studies suggest that albuminuria, a biomarker of endothelial injury, is increased in patients with COPD.

OBJECTIVES:

To test whether albuminuria was associated with lung function decline and incident CLRDs.

METHODS:

Six U.S. population-based cohorts were harmonized and pooled. Participants with prevalent clinical lung disease were excluded. Albuminuria (urine albumin-to-creatinine ratio) was measured in spot samples. Lung function was assessed by spirometry. Incident CLRD-related hospitalizations and deaths were classified via adjudication and/or administrative criteria. Mixed and proportional hazards models were used to test individual-level associations adjusted for age, height, weight, sex, race/ethnicity, education, birth year, cohort, smoking status, pack-years of smoking, renal function, hypertension, diabetes, and medications.

MEASUREMENTS AND MAIN RESULTS:

Among 10,961 participants with preserved lung function, mean age at albuminuria measurement was 60 years, 51% were never-smokers, median albuminuria was 5.6 mg/g, and mean FEV1 decline was 31.5 ml/yr. For each SD increase in log-transformed albuminuria, there was 2.81% greater FEV1 decline (95% confidence interval [CI], 0.86-4.76%; P = 0.0047), 11.02% greater FEV1/FVC decline (95% CI, 4.43-17.62%; P = 0.0011), and 15% increased hazard of incident spirometry-defined moderate-to-severe COPD (95% CI, 2-31%, P = 0.0021). Each SD log-transformed albuminuria increased hazards of incident COPD-related hospitalization/mortality by 26% (95% CI, 18-34%, P < 0.0001) among 14,213 participants followed for events. Asthma events were not significantly associated. Associations persisted in participants without current smoking, diabetes, hypertension, or cardiovascular disease.

CONCLUSIONS:

Albuminuria was associated with greater lung function decline, incident spirometry-defined COPD, and incident COPD-related events in a U.S. population-based sample.

• Authors: Elizabeth C Oelsner, Pallavi P Balte, Morgan E Grams, Patricia A Cassano, David R Jacobs, R Graham Barr, Kristin M Burkart, Ravi Kalhan, Richard Kronmal, Laura R Loehr, George T O'Connor, Joseph E Schwartz, Michael Shlipak, Russell P Tracy, Michael Y Tsai, Wendy White, Sachin Yende
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 199 Issue 3 Pg. 321-332 (02 01 2019) ISSN: 1535-4970 [Electronic] United States
• PMID: 30261735 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Aged
• Albuminuria (epidemiology, physiopathology)
• Cohort Studies
• Comorbidity
• Female
• Humans
• Incidence
• Lung (physiopathology)
• Male
• Middle Aged
• National Heart, Lung, and Blood Institute (U.S.)
• Pulmonary Disease, Chronic Obstructive (epidemiology, physiopathology)
• Respiratory Function Tests
• Risk Factors
• United States (epidemiology)