Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality

Nayili Mahemuti1; Jiao Zou1; Chuanlang Liu1; Zhiyi Xiao2; Fengchao Liang2; Xueli Yang1,3,4

2023-12-01

10.1001/jamanetworkopen.2023.48333

JAMA Network Open   影响因子和分区

2574-3805

Importance Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR.Objective To investigate associations of traditionally normal UACR and CVH with all-cause mortality.Design, Setting, and Participants This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria.Exposures The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points).Main Outcomes and Measures Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups.Results The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001).Conclusions and Relevance The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.

SCI

英语

通讯

Fundamental Research Funds for Higher Education of the Tianjin Municipal Education Commission[2021ZD038]

General & Internal Medicine

Medicine, General & Internal

WOS:001130400500002

AMER MEDICAL ASSOC

人工提交

1.Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China.
2.School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China.
3.Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, Tianjin Medical University, Tianjin, China.
4.Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China.

Nayili Mahemuti,Jiao Zou,Chuanlang Liu,et al. Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality[J]. JAMA Network Open,2023,6(12):e2348333.

Nayili Mahemuti,Jiao Zou,Chuanlang Liu,Zhiyi Xiao,Fengchao Liang,&Xueli Yang.(2023).Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality.JAMA Network Open,6(12),e2348333.

Nayili Mahemuti,et al."Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality".JAMA Network Open 6.12(2023):e2348333.