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Heart Rhythm. 2017 Jan;14(1):65-71. doi: 10.1016/j.hrthm.2016.08.004. Epub 2016 Aug 11.

Albuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Author information

1
Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Rajat.Deo@uphs.upenn.edu.
2
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
3
Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California.
4
Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina.
5
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
6
Departments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
7
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
8
Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois.
9
Center for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
10
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.

Abstract

BACKGROUND:

Moderate-to-severe kidney disease increases risk for sudden cardiac death (SCD). Limited studies have evaluated how mild degrees of kidney dysfunction impact SCD risk.

OBJECTIVE:

The purpose of this study was to evaluate the association of albuminuria, which is one of the earliest biomarkers of kidney injury, and SCD.

METHODS:

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective, population-based cohort of U.S. adults. Associations between albuminuria, which is categorized using urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and SCD were assessed independently and in combination.

RESULTS:

After median follow-up of 6.1 years, we identified 335 SCD events. Compared to participants with ACR <15 mg/g, those with higher levels had an elevated adjusted risk of SCD (ACR 15-30 mg/g, hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.11-2.11; ACR >30 mg/g, HR 1.56, 95% CI 1.17-2.11). In contrast, compared to the group with eGFR >90 mL/min/1.73 m2, the adjusted risk of SCD was significantly elevated only among those with eGFR <45 mL/min/1.73 m2 (HR 1.66, 95% CI 1.06-2.58). The subgroup with eGFR <45 mL/min/1.73 m2 (n = 1003) comprised 3.7% of REGARDS, whereas ACR 15-30 mg/g (n = 3089 [11.3%]) and ACR >30 mg/g (n = 4040 [14.8%] were far more common. In the analysis that combined ACR and eGFR categories, albuminuria consistently identified individuals with eGFR ≥60 mLmin/1.73 m2 who were at significantly increased SCD risk.

CONCLUSION:

Low levels of kidney injury as measured by ACR predict an increase in SCD risk.

KEYWORDS:

Albuminuria; Kidney function; Population health; Risk factor; Sudden cardiac death

PMID:
27523775
PMCID:
PMC5256547
DOI:
10.1016/j.hrthm.2016.08.004
[Indexed for MEDLINE]
Free PMC Article

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