Schutte Rudolph, Schmieder Roland E, Huisman Hugo W, Smith Wayne, van Rooyen Johannes M, Fourie Carla M T, Kruger Ruan, Uys Lisa, Ware Lisa, Mels Catharina M C, Greeff Minrie, Kruger Iolanthé M, Schutte Aletta E
Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa.
Am J Hypertens. 2014 Jun;27(6):811-8. doi: 10.1093/ajh/hpt288. Epub 2014 Feb 10.
Increased urinary albumin excretion reflects general vascular damage and predicts adverse cardiovascular and renal outcomes. Albuminuria can be determined from easily collected spot urine samples, especially in low-resource settings. However, no prognostic evidence exists for Africans.
We followed clinical outcomes in 1,061 randomly selected non diabetic, human immunodeficiency virus (HIV)-negative Africans (mean age: 51.5 years; 62.0% women). Baseline urinary albumin-to-creatinine ratio was assessed from spot urine samples.
Over a median follow-up of 4.52 years, 132 deaths occurred, of which 47 were cardiovascular related. The urinary albumin-to-creatinine ratio averaged 6.1 μg/mg (5th to 95th percentile interval; 1.2-70.0). In multivariable-adjusted analyses, urinary albumin excretion predicted all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.07-1.48; P = 0.006), and a tendency existed for cardiovascular mortality (HR, 1.26; 95% CI, 0.97-1.63; P = 0.087), which seemed to be driven by fatal stroke (HR, 1.72; 95% CI, 1.17-2.54; P = 0.006) rather than cardiac mortality (HR, 0.67; 95% CI, 0.41-1.07; P = 0.094). The predictive value remained in 528 hypertensives for both all-cause (HR, 1.38; 95% CI, 1.13-1.69; P = 0.001) and cardiovascular (HR, 1.45; 95% CI, 1.07-1.96; P = 0.017) mortality, again driven by stroke. Our findings also remained significant after we excluded participants with macroalbuminuria, those on antihypertensive treatment, as well as participants who died within 1 year after enrollment.
In nondiabetic HIV-negative Africans, albuminuria predicts all-cause and stroke mortality.
尿白蛋白排泄增加反映全身血管损伤，并可预测不良心血管和肾脏结局。尿白蛋白可通过易于采集的随机尿样测定，尤其在资源匮乏地区。然而，非洲人群中尚无相关预后证据。
我们对1061名随机选取的非糖尿病、人类免疫缺陷病毒（HIV）阴性非洲人（平均年龄：51.5岁；62.0%为女性）的临床结局进行了随访。通过随机尿样评估基线尿白蛋白肌酐比值。
在中位随访4.52年期间，发生了132例死亡，其中47例与心血管疾病相关。尿白蛋白肌酐比值平均为6.1μg/mg（第5至95百分位数区间；1.2 - 70.0）。在多变量调整分析中，尿白蛋白排泄可预测全因死亡率（风险比（HR），1.26；95%置信区间（CI），1.07 - 1.48；P = 0.006），且存在心血管死亡率升高的趋势（HR，1.26；95% CI，0.97 - 1.63；P = 0.087），这似乎是由致命性卒中（HR，1.72；95% CI，1.17 - 2.54；P = 0.006）而非心脏死亡率（HR，0.67；95% CI，0.41 - 1.07；P = 0.094）所驱动。在528例高血压患者中，尿白蛋白排泄对全因死亡率（HR，1.38；95% CI，1.13 - 1.69；P = 0.001）和心血管死亡率（HR，1.45；95% CI，1.07 - 1.96；P = 0.017）仍具有预测价值，同样由卒中所驱动。在排除大量白蛋白尿患者、接受抗高血压治疗的患者以及入组后1年内死亡的患者后，我们的研究结果依然显著。
在非糖尿病HIV阴性非洲人中，蛋白尿可预测全因死亡率和卒中死亡率。
