Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: a 4.4-year follow-up study. The Nord-Trøndelag Health Study (HUNT), Norway

Am J Kidney Dis. 2003 Sep;42(3):466-73. doi: 10.1016/s0272-6386(03)00742-x.


Background: To date, there are few large follow-up studies of apparently healthy subjects with microalbuminuria (MA). The aim of this study is to examine the association between MA and all-cause mortality in nondiabetic nonhypertensive individuals.

Methods: We conducted a 4.4-year mortality follow-up of 2,089 men and women (> or =20 years) without diabetes and treated hypertension, randomly selected from the population-based Nord-Trøndelag Health Study (1995 to 1997; n = 65,258). Main outcome measures were adjusted relative risk (RR) for all-cause mortality according to increasing albuminuria, defined at different albumin-creatinine ratio (ACR) levels and in 1/2 or 3 urine samples. The main analysis was performed after exclusion of those with cardiovascular disease.

Results: There was a positive association between all-cause mortality and MA. The lowest ACR level associated with increased RR for mortality was the 60th percentile (> or =6.7 microg/mg [0.76 mg/mmol]; RR, 2.4; 95% confidence interval, 1.1 to 5.2), applying 3 urine samples with an ACR greater than the cutoff level. We found a positive association between mortality and increasing numbers of urine samples with an ACR greater than different cutoff levels, in which 3 urine samples were superior. Results persisted after adjusting for several confounders and excluding individuals with untreated hypertension (systolic blood pressure > or = 140 mm Hg/diastolic blood pressure > or = 90 mm Hg) and those who died during the first year of follow-up.

Conclusion: Although this study confirms the association of all-cause mortality and ACR level in apparently healthy individuals, intervention trials are necessary before clinical cutoff levels of ACR are established and before screening programs are recommended.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albuminuria / epidemiology*
  • Blood Glucose / analysis
  • Body Mass Index
  • Creatinine / blood
  • Elder Abuse
  • Female
  • Follow-Up Studies
  • Health Surveys
  • Humans
  • Lipids / blood
  • Male
  • Middle Aged
  • Mortality*
  • Norway / epidemiology
  • Proportional Hazards Models
  • Risk
  • Smoking / epidemiology


  • Blood Glucose
  • Lipids
  • Creatinine