High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria: A prospective cohort study

Int J Cardiol. 2013 Dec 10;170(2):167-72. doi: 10.1016/j.ijcard.2013.10.076. Epub 2013 Oct 29.


Background: The reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated.

Methods: A total of 16,759 participants aged 40 to 69 years with normal or mildly reduced eGFR (45-119 ml/min/1.73 m(2)) were enrolled and divided into six groups (group 1, eGFR: 90-119 without albuminuria; group 2, eGFR: 90-119 with albuminuria; group 3, eGFR: 60-89 without albuminuria (reference); group 4, eGFR: 60-89 with albuminuria; group 5, eGFR: 45-59 without albuminuria; group 6, eGFR: 45-59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin-creatinine ratio ≥ 30 mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis.

Results: The highest risk of ACD (RR (95% CIs): 3.95 (2.08-7.52)), CVD (7.15 (2.25-22.7)) and NPB (3.25 (1.26-8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA1c and the highest prevalence of diabetes and metabolic syndrome.

Conclusion: Coexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population.

Keywords: Albuminuria; Chronic kidney disease; Estimated glomerular filtration rate; Mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albuminuria / mortality*
  • Albuminuria / physiopathology
  • Cardiovascular Diseases / mortality*
  • Diabetes Complications / mortality
  • Female
  • Glomerular Filtration Rate / physiology*
  • Glycated Hemoglobin / metabolism
  • Humans
  • Infections / mortality
  • Male
  • Metabolic Syndrome / mortality
  • Middle Aged
  • Multivariate Analysis
  • Neoplasms / mortality
  • Poisson Distribution
  • Prevalence
  • Renal Insufficiency, Chronic / mortality*
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human