Racial differences in albuminuria, kidney function, and risk of stroke

Gutiérrez, Orlando M.; Judd, Suzanne E.; Muntner, Paul; Rizk, Dana V.; McClellan, William M.; Safford, Monika M.; Cushman, Mary; Kissela, Brett M.; Howard, Virginia J.; Warnock, David G.

doi:10.1212/wnl.0b013e31826e9af8

Cited by 38 publications

(31 citation statements)

References 39 publications

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“…18 Similarly, we previously showed that the risk of incident stroke associated with any given strata of urinary ACR above the normal range was significantly higher in blacks than in whites even after accounting for traditional cardiovascular risk factors and eGFR. 6 The results of the current study extend these findings by showing that higher urinary ACR confers a 2-fold higher relative risk of incident CHD in blacks compared to whites with an ACR ≥30mg/g. While the absolute risk differences in the two highest categories of ACR were relatively small (~4 and 7 extra events per 1,000 person years of follow-up in blacks vs. whites, respectively), given the link between elevated urinary ACR and systemic microvascular injury, 19–22 these data suggest that blacks have greater susceptibility to vascular disease than whites, which in turn may account for much of their excess risk of cardiovascular disease events such as stroke and CHD.…”

Section: Commentsupporting

confidence: 81%

“…1 Black individuals have higher levels of urinary albumin excretion than white individuals, 2–6 which may contribute to racial disparities in cardiovascular outcomes. In support of this, in participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study free of stroke at baseline, we previously showed that the association of urinary ACR with incident stroke differed by race, such that higher urinary ACR was independently associated with a higher risk of incident stroke in blacks but not in whites.…”

Section: Introductionmentioning

confidence: 99%

“…In support of this, in participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study free of stroke at baseline, we previously showed that the association of urinary ACR with incident stroke differed by race, such that higher urinary ACR was independently associated with a higher risk of incident stroke in blacks but not in whites. 6 While these data suggest that higher urinary albumin excretion may be a stronger risk factor for cardiovascular disease events in blacks than in whites, little is known about racial differences in the association of urinary ACR with cardiovascular outcomes apart from stroke events. In particular, no study to our knowledge has specifically examined whether the association of urinary ACR and coronary heart disease (CHD) differs by race.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults

Gutiérrez

Khodneva

Muntner

et al. 2013

JAMA

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Importance Excess urinary albumin excretion is more common in black individuals than in white individuals and is more strongly associated with incident stroke risk in blacks than whites. Whether similar associations extend to coronary heart disease (CHD) is unclear. Objective To determine whether the association of urinary albumin excretion with CHD events differs by race. Design, Setting and Participants Within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort of black and white US adults ≥45 years of age enrolled between 2003 and 2007 with follow-up through December 31 2009, we examined race-stratified associations of urinary albumin to creatinine ratio (ACR) with (1) incident CHD among 23,273 participants free of CHD at baseline, and (2) first recurrent CHD event among 4,934 participants with CHD at baseline. Main Outcome Measure Expert-adjudicated incident and recurrent myocardial infarction (MI) and acute CHD death. Results A total of 616 incident CHD events (421 non-fatal MIs and 195 CHD deaths) and 468 recurrent CHD events (279 non-fatal MIs and 189 CHD deaths) were observed over a mean 4.4 years of follow-up. Among those free of CHD at baseline, age- and sex-adjusted incidence rates of CHD per 1000 person-years of follow-up increased with increasing categories of ACR in blacks and whites, with rates being nearly 1.5-fold higher in the highest category of ACR (>300 mg/g) in blacks vs. whites (20.59, 95% confidence interval [14.36,29.51] in blacks vs. 13.60 [7.60,24.25] in whites). In proportional hazards models adjusted for traditional cardiovascular risk factors and medications, higher baseline urinary ACR was associated with higher risk of incident CHD among blacks (hazard ratio [HR] comparing ACR >300 vs. <10 mg/g, 3.21 [2.02,5.09]) but not whites (HR comparing ACR >300 vs. <10 mg/g, 1.49 [0.80,2.76]) (P-interaction=0.03). Among those with CHD at baseline, fully-adjusted associations of baseline urinary ACR with first recurrent CHD event were similar in blacks and whites (HR comparing ACR >300 vs. <10 mg/g, 2.21 [1.22,4.00] in blacks vs. 2.48 [1.61,3.78] in whites) (P-interaction=0.53). Conclusions Higher urinary ACR was associated with higher risk of incident but not recurrent CHD in blacks compared to whites.

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Section: Commentsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults

Gutiérrez

Khodneva

Muntner

et al. 2013

JAMA

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“…Population studies have shown that modest increases in urine albumin excretion well within the normal range of <30 mg are still relevant as they are predictive of higher mortality and ESRD risk [39–41]. It is unclear if the source of the MCP-1 is interstitial versus glomerular, since increased glomerular leak of albumin or decreased tubular reabsorption could both results in increased urinary albumin excretion.…”

Section: Discussionmentioning

confidence: 99%

Tubulointerstitial Fibrosis of Living Donor Kidneys Associates with Urinary Monocyte Chemoattractant Protein 1

Wang

Lieske

Alexander³

et al. 2016

Am J Nephrol

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Background: Non-invasive biomarkers that detect occult pathology in patients with normal glomerular filtration rate (GFR) and normal urine albumin excretion may help identify patients at risk for chronic kidney diseases. Methods: Two promising biomarkers of interstitial fibrosis, urinary monocyte chemoattractant protein 1 (MCP-1) and collagen IV, were assayed among 634 living kidney donors from 2005 to 2011, who had both a frozen pre-donation spot urine sample and a core needle biopsy of their donated kidney at transplantation (‘time zero biopsy'). The association of urine MCP-1 and collagen IV with kidney function (GFR and urine albumin excretion), kidney volume on computed tomographic imaging and histological findings was assessed. Results: The mean ± SD age was 45 ± 12 years, 24-hour urine albumin was 4 ± 7 mg and measured GFR (mGFR) was 102 ± 18 ml/min/1.73 m². The median (25th-75th percentile) urine level of MCP-1 was 146 (54-258) pg/ml and of collagen IV was 2.0 (1.0-3.5) µg/l. Higher urine MCP-1 associated with higher 24-hour urine albumin excretion; higher urine collagen IV associated with male gender. On kidney biopsy, any interstitial fibrosis was present in 22% and fibrosis >5% in 4% of donors. The mean MCP-1/Cr ratio was 1.49 pg/mg for 0% fibrosis, 1.80 pg/mg for 1-5% fibrosis, 2.33 pg/mg for 6-10% fibrosis and 4.33 pg/mg for >10% fibrosis. After adjustment for age, sex, mGFR and 24-hour urine albumin, higher urine MCP-1 but not collagen IV associated with interstitial fibrosis and tubular atrophy. Conclusion: Urine MCP-1 may detect early tubulointerstitial fibrosis in adults with normal kidney function.

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“…A reduced estimated glomerular fi ltration rate (eGFR) has also been associated with a higher risk for fatal and nonfatal stroke, but the aggregate literature is not consistent [ 94 , 95 ] and there are limited data on measures of kidney function and stroke risk in blacks. In an examination of the association of eGFR and urinary albumin excretion (measured as albumin-to-creatinine ratio, ACR) with incident stroke in REGARDS, a higher ACR was found to be independently associated with higher stroke risk in black, but not white participants [ 95 ]. An editorial accompanying the paper suggests that albuminuria could be an important new marker for uncontrolled hypertension in blacks, reemphasizing the need for diagnosis of the underlying pathophysiology of the hypertension and an individualized approach to managing BP levels to reduce stroke risk in blacks [ 54 ].…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Stroke and Hypertension in High-Risk African Americans

Howard

Petrov

Dudenbostel

et al. 2014

Hypertension in High Risk African Americans

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Stroke is primarily an "end-organ" outcome of atherosclerotic and hypertensive diseases and embolic disease usually arising from the heart or aorta. The most common type of stroke is ischemic stroke, the result of cerebral vessel occlusion from the accumulation of arteriosclerotic plaque or thrombi that develop in remote blood vessels and migrate to the smaller cerebral arteries, resulting in the death of brain tissue. The less common type of stroke is hemorrhagic, due to bleeding from a ruptured vessel within the brain [parenchymal or intracerebral hemorrhage (ICH)] or around the brain [subarachnoid hemorrhage (SAH).] It is estimated that 87 % of all strokes are ischemic, 10 % ICH, and 3 % SAH [ 1 ] with ischemic stroke having an overall lower risk of fatality than either ICH or SAH [ 2 ]. In 2010, stroke was the fourth leading cause of death in the United States (USA), followed by diseases of the heart, cancer, and chronic lower respiratory diseases [ 1 ]. Moreover, it is estimated that 6.8

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Racial differences in albuminuria, kidney function, and risk of stroke

Abstract: Background:The objective of this study was to examine the joint associations of estimated glo-

Cited by 38 publications

References 39 publications

Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults

Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults

Tubulointerstitial Fibrosis of Living Donor Kidneys Associates with Urinary Monocyte Chemoattractant Protein 1

Stroke and Hypertension in High-Risk African Americans

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