Albuminuria, kidney function, and sudden cardiac death: Findings from The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study

• Type of Material: Article
• Authors: Rajat Deo, University of Pennsylvania; Yulia A. Khodneva, University of Alabama; Michael G. Shlipak, University of California, San Francisco; Elsayed Z. Soliman, Wake Forest University; Suzanne E. Judd, University of Alabama; William McClellan, Emory University; Todd M. Brown, University of Alabama; J. David Rhodes, University of Alabama; Orlando M. Gutiérrez, University of Alabama; Sanjiv J. Shah, Northwestern University; Christine M. Albert, Brigham and Women's Hospital and Harvard Medical School; Monika M. Safford, Weill Cornell Medical College
• Language: English
• Date: 2017-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Heart Rhythm Society
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.hrthm.2016.08.004
• Title of Journal or Parent Work: Heart Rhythm
• ISSN: 1547-5271
• Volume: 14
• Issue: 1
• Start Page: 65
• End Page: 71
• Grant/Funding Information: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service.; Dr. Deo was supported by grant K23DK089118 from the National Institutes of Health.; The REGARDS-MI study was supported by NIH grants R01 HL080477 and K24 HL111154.
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics; Health Sciences, Epidemiology

Abstract

Background: Moderate-to-severe kidney disease increases risk for sudden cardiac death (SCD). Limited studies have evaluated how mild degrees of kidney dysfunction impact SCD risk. Objective: The purpose of this study was to evaluate the association of albuminuria, which is one of the earliest biomarkers of kidney injury, and SCD. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective, population-based cohort of U.S. adults. Associations between albuminuria, which is categorized using urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and SCD were assessed independently and in combination. Results: After median follow-up of 6.1 years, we identified 335 SCD events. Compared to participants with ACR < 15 mg/g, those with higher levels had an elevated adjusted risk of SCD (ACR 15–30 mg/g, hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.11–2.11; ACR > 30 mg/g, HR 1.56, 95% CI 1.17–2.11). In contrast, compared to the group with eGFR > 90 mL/min/1.73 m 2 , the adjusted risk of SCD was significantly elevated only among those with eGFR < 45 mL/min/1.73 m 2 (HR 1.66, 95% CI 1.06–2.58). The subgroup with eGFR < 45 mL/min/1.73 m 2 (n = 1003) comprised 3.7% of REGARDS, whereas ACR 15–30 mg/g (n = 3089 [11.3%]) and ACR > 30 mg/g (n = 4040 [14.8%] were far more common. In the analysis that combined ACR and eGFR categories, albuminuria consistently identified individuals with eGFR ≥60 mLmin/1.73 m 2 who were at significantly increased SCD risk. Conclusion: Low levels of kidney injury as measured by ACR predict an increase in SCD risk.