Albuminuria and Estimated Glomerular Filtration Rate Independently Associate with Acute Kidney Injury
- Morgan E. Grams*,
- Brad C. Astor*†,
- Lori D. Bash†,
- Kunihiro Matsushita†,
- Yaping Wang‡ and
- Josef Coresh*†‡
- *Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- Departments of †Epidemiology and
- ‡Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Correspondence:
Dr. Josef Coresh, Director, Cardiovascular Epidemiology and Comstock Center, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287. Phone: 410-955-0495; Fax: 410-955-0476; E-mail: coresh{at}jhu.edu
- Received for publication January 30, 2010.
- Accepted for publication April 20, 2010.
Abstract
Acute kidney injury (AKI) is increasingly common and a significant contributor to excess death in hospitalized patients. CKD is an established risk factor for AKI; however, the independent graded association of urine albumin excretion with AKI is unknown. We analyzed a prospective cohort of 11,200 participants in the Atherosclerosis Risk in Communities (ARIC) study for the association between baseline urine albumin-to-creatinine ratio and estimated GFR (eGFR) with hospitalizations or death with AKI. The incidence of AKI events was 4.0 per 1000 person-years of follow-up. Using participants with urine albumin-to-creatinine ratios <10 mg/g as a reference, the relative hazards of AKI, adjusted for age, gender, race, cardiovascular risk factors, and categories of eGFR were 1.9 (95% CI, 1.4 to 2.6), 2.2 (95% CI, 1.6 to 3.0), and 4.8 (95% CI, 3.2 to 7.2) for urine albumin-to-creatinine ratio groups of 11 to 29 mg/g, 30 to 299 mg/g, and ≥300 mg/g, respectively. Similarly, the overall adjusted relative hazard of AKI increased with decreasing eGFR. Patterns persisted within subgroups of age, race, and gender. In summary, albuminuria and eGFR have strong, independent associations with incident AKI.
- Copyright © 2010 by the American Society of Nephrology
