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Prev Med. 2015 Sep;78:72-7. doi: 10.1016/j.ypmed.2015.07.009. Epub 2015 Jul 17.

Dipstick proteinuria as a predictor of all-cause and cardiovascular disease mortality in Bangladesh: A prospective cohort study.

Author information

1
Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine (Section of Pulmonary/Critical Care), Harlem Hospital affiliated with Columbia University, New York, NY, United States. Electronic address: grp4@cumc.columbia.edu.
2
Dept. of Health Sciences, University of Chicago, IL, United States.
3
Dept. of Environmental Medicine, New York University School of Medicine, New York, NY, United States.
4
Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States.
5
University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.
6
Dept. of Public Health Studies, Penn State College of Medicine, Hershey, PA, United States.
7
Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine, Columbia University, New York, NY, United States.
8
Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Health Sciences, University of Chicago, IL, United States; Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States; University of Chicago Research (URB), Ltd., Dhaka, Bangladesh.

Abstract

OBJECTIVE:

Baseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality.

METHODS:

Baseline data was collected from 2000 to 2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11-12years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam.

RESULTS:

Baseline proteinuria of 1+ or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71-4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81-6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1+ proteinuria had a stronger risk of death, 3.49 (1.64-7.41)-fold greater, than no proteinuria. Incident 1+ proteinuria had a 1.87 (0.92-3.78)-fold greater mortality over 9-10years. Remittent proteinuria revealed no increased mortality.

CONCLUSIONS:

Baseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1+ dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension.

KEYWORDS:

Bangladesh mortality; Dipstick proteinuria and mortality; Epidemiology; Proteinuria and all-cause mortality; Proteinuria and cardiovascular disease mortality

PMID:
26190365
PMCID:
PMC4718561
DOI:
10.1016/j.ypmed.2015.07.009
[Indexed for MEDLINE]
Free PMC Article

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