Non-albumin proteinuria is associated with all-cause mortality in community-dwelling adults

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Non-albumin proteinuria is associated with all-cause mortality in community-dwelling adults

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Co-author 1

Keiko Kabasawa keikoyk@med.niigata-u.ac.jp Niigata University Graduate School of Medical and Dental Sciences Department of Health Promotion Medicine Niigata Japan *

Co-author 2

Michihiro Hosojima hoso9582@med.niigata-u.ac.jp Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences Department of Clinical Nutrition Science Niigata Japan -

Co-author 3

Yumi Ito yumii@med.niigata-u.ac.jp Niigata University Graduate School of Medical and Dental Sciences Department of Health Promotion Medicine Niigata Japan -

Co-author 4

Hideyuki Kabasawa hkabasawa@med.niigata-u.ac.jp Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences Department of Clinical Nutrition Science Niigata Japan -

Co-author 5

Noriaki Iino niino@med.niigata-u.ac.jp Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital Department of Nephrology Minamiuonuma Japan -

Co-author 6

Akihiko Saito akisaito@med.niigata-u.ac.jp Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences Division of Clinical Nephrology and Rheumatology Niigata Japan -

Co-author 7

Suguru Yamamoto yamamots@med.niigata-u.ac.jp Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences Division of Clinical Nephrology and Rheumatology Niigata Japan -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Non-albumin proteinuria (NAP), the presence of proteins other than albumin in urine, involves a wide range of urinary proteins that reflect mainly tubular injury and is reported to be associated with mortality in hospital settings. This study examined the association of NAP with all-cause mortality, compared with albuminuria and proteinuria, in community-dwelling adults.

Methods

A community-based prospective cohort study conducted in Japan included 6,601 participants (aged 40–97 years, 48.0% women). We assessed NAP as the difference between the urine albumin-to-creatinine ratio (ACR) and the urine protein-to-creatinine ratio (PCR). The associations of NAP, ACR, and PCR with all-cause mortality and secondarily cause of death were assessed by multivariable Cox hazard regression analysis with adjustment for potential confounders.

Results

The median NAP, ACR, and PCR values were 27.3 mg/g, 11.0 mg/g, and 40.8 mg/g, respectively, with a median eGFR of 73.7 mL/min/1.73 m². During a median follow-up of 11.2 years, 1,182 events occurred. For a doubling of NAP, ACR, and PCR, the adjusted hazard ratios (95% CI) for all-cause mortality were 1.16 (1.11, 1.21), 1.12 (1.08, 1.16), and 1.18 (1.13, 1.23), respectively. When further adjusted for ACR levels, NAP was significantly associated with all-cause mortality (adjusted hazard ratio [95% CI], 1.12 [1.06, 1.18]). NAP demonstrated a similar positive association with cardiovascular mortality.

Conclusion

This prospective study found a positive association between NAP and all-cause mortality independent of ACR levels in community-dwelling adults. NAP can be a useful potential marker for identifying high-risk populations for mortality, regardless of albuminuria levels.

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