Level of Albuminuria and Risk of Stroke: Systematic Review and Meta-Analysis

Abstract

Background: Gross albuminuria is associated with increased stroke risk, but it is unclear whether stroke incidence varies by level of albuminuria. We meta-analyzed prospective cohort studies to investigate the impact of various albuminuria levels and continuous urinary albumin excretion (UAE) change on stroke risk. Methods: Systematic search for studies reporting quantitative estimates of the multivariate-adjusted relative risk (RR) and 95% CI for stroke risk associated with microalbuminuria (UAE 30–300 mg/day or nearest equivalent interval) and macroalbuminuria (UAE >300 mg/day) and studies that analyzed the relation of stroke with UAE continuously. Estimates were combined using a random-effect model. Results: We identified seven studies comprising 46,638 participants with 1,479 stroke events. Incident stroke risk was greater for macroalbuminuria (RR 2.65, 95% CI 2.25–3.14) than microalbuminuria (RR 1.58, 95% CI 1.39–1.80), a difference that was significant (p for heterogeneity < 0.001, I² = 96%). In addition, risk of stroke increased proportionally with rising UAE (p < 0.001), even for UAE within normal range (beginning from levels as low as 2–4 mg/g). Conclusions: Higher albuminuria level confers greater stroke risk. These findings provide additional weight to evidence that albuminuria is strongly linked to stroke risk, and suggest that persons with elevated UAE levels may especially benefit from more intensive vascular risk reduction.

Proteinuria, but Not eGFR, Predicts Stroke Risk in Chronic Kidney Disease

“…Our study extends this finding to cerebrovascular disease and suggests that albuminuria can be used to predict the risk of stroke in individuals with known CKD. Prior studies have found an association of albuminuria with incident stroke in the general population 23–26 , but this is the first study to assess the association of renal biomarkers with stroke risk specifically in individuals with CKD. Our study bolsters these earlier reports in a diverse sample of patients with CKD from a variety of etiologies.…”

“…The incidence of stroke in our population is similar to that reported in other studies of stroke in patients with kidney dysfunction. 23 Medical history and medication use were self-reported by participants. Medication indication, compliance and/or effectiveness were not assessed.…”

Relationship between serum irisin levels and urinary albumin excretion in patients with type 2 diabetes

“…Urinary albumin excretion (UAE) has been strongly linked to cardiovascular disease in persons with or without diabetes mellitus (Lee, Saver, Chang, & Ovbiagele, 2010). Moreover microalbuminuria, a marker of endothelial dysfunction, might be associated with pathophysiologic processes leading to cardiovascular diseases in patients with type 2 diabetes (Abdelhafiz, Ahmed, & El Nahas, 2011;Turkmen et al, 2014).…”

Microalbuminuria

“…MA is more prevalent in patients with increased risk of vascular events (e.g., diabetics and patients with hypertension) [3]. It predicts cardiovascular events and all-cause mortality in the general population and is a plausible risk factor for ischemic stroke [3].…”

“…It predicts cardiovascular events and all-cause mortality in the general population and is a plausible risk factor for ischemic stroke [3]. Furthermore, MA occurs transiently in acute diseases with different etiologies and predicts greater short-and long-term mortality in stroke patients [4].…”