An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population

Background. We questioned which factors determine the risk for developing renal function impairment. To that purpose, we studied the incidence of newly diagnosed impaired renal function (GFR <60 mL/min/1.73m(2)) in the PREVEND cohort (N = 8592), which is enriched for the presence of albuminuria, and which was first studied in 1997-1998. Of this cohort, 6894 subjects were studied again four years later. Methods. Subjects with known renal disease, GFR <60 mL/min, missing GFR values, or sediment abnormalities at the first screening were excluded from the present. analysis (N = 872). We examined whether albuminuria is associated with the de novo development of an impaired renal function. GFR was 90.3 (SD 16.3) mL/min/1.73m(2) at baseline, and 11.6% of the subjects had an albuminuria of more than 30 mg/day. Results. After a follow-up of four years, 253 subjects (4.2%) were found to have a GFR <60 mL/min/1.73m(2). The subjects with newly diagnosed impaired GFR were older, had a higher blood pressure, serum cholesterol, plasma glucose, and urinary albumin excretion at the first examination, and had a lower GFR to start with than those with a GFR >60 at the second evaluation. Subjects with de novo impaired GFR had a comparable BMI and smoked less frequently compared with subjects with GFR >60. In multivariate analysis, urinary albumin excretion was independently predictive for the risk of developing an impaired GFR (P = 0.001). Conclusion. Also in the general population, measurement of urinary albumin excretion may prove to be a valuable tool to detect subjects at risk for later development of renal failure, independent of the presence of other cardiovascular risk factors.