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Reduced Kidney Function, Albuminuria, and Risks for All-cause and Cardiovascular Mortality in China: A
Jinwei Wang1,2,3,4, Fang Wang1,2,3,4, Shiwei Liu1,2,3,4,5
1Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, China.
Insights
Albuminuria significantly increases mortality risk in Chinese adults, while reduced kidney function
Area of Science:
- Nephrology
- Epidemiology
- Public Health
Background:
- Reduced kidney function and albuminuria are linked to higher mortality and cardiovascular risks.
- Evidence from Asian populations regarding these risks is limited.
- This study investigated chronic kidney disease (CKD) indicators and mortality in China.
Purpose of the Study:
- To examine the association between CKD indicators (eGFR and ACR) and all-cause mortality.
- To assess the link between CKD indicators and cardiovascular mortality.
- To provide insights into CKD risks within the Chinese general population.
Main Methods:
- An observational study of 47,204 Chinese adults.
- Cross-sectional survey data with survival status tracked until December 31, 2013.
- Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used as CKD indicators.
Main Results:
- Both all-cause and cardiovascular mortality rates increased with reduced eGFR or elevated ACR.
- Elevated ACR was significantly associated with increased all-cause and cardiovascular mortality risk.
- Reduced eGFR was not a clear predictor, but its association with mortality was prominent in those under 65.
Conclusions:
- Albuminuria is linked to increased all-cause and cardiovascular mortality in the Chinese population.
- The association between reduced kidney function and all-cause mortality requires further clarification.
- Albuminuria serves as a significant mortality risk indicator in this population.
Background:
Previous studies have indicated that reduced kidney function and albuminuria are associated with increased risk of mortality and adverse cardiovascular outcomes, however, the evidence from the Asian population is limited. We investigated the association between the indicators of chronic kidney disease (CKD) and all-cause mortality, as well as cardiovascular mortality among a general population in China.
Methods:
We conducted an observational study among 47,204 Chinese adults, from a cross-sectional survey, whose survival status is identified through December 31, 2013. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used as indicators of CKD. We determined the rates of all-cause and cardiovascular mortality.
Results:
The incidence rates for both all-cause and cardiovascular mortality increased with the advanced stages of reduced eGFR or elevated ACR. Elevated ACR levels were found to be significantly associated with increased risk of both all-cause and cardiovascular mortality, as shown in the Cox proportional hazards regression model. The multivariable adjusted hazard ratios (HR) associated with all-cause mortality were 1.26 (95% confidence interval [CI]: 1.04-1.53) for those with ACR 30-299 mg/g and 2.07 (95% CI: 1.40-3.04) with ACR ≥ 300 mg/g, compared to those with ACR <30 mg/g. The corresponding HRs for the above ACR levels associated with cardiovascular mortality were 1.08 (95% CI: 0.77-1.50) and 2.32 (95% CI: 1.31-4.12), respectively. We did not identify reduced eGFR as a risk predictor in the multivariable adjusted model for the adverse outcomes in the population, however, an interaction between eGFR and age were detected. Stratified analyses revealed that the associations of reduced eGFR (<60 mL/min/1.73 m2) with all-cause mortality were prominent among participants aged less than 65 years.
Conclusions:
Albuminuria was associated with an elevated risk of all-cause and cardiovascular mortality among the Chinese population, however, the association of reduced kidney function with all-cause mortality was not clear.
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