03207nas a2200337 4500008004100000022001400041245013200055210006900187260001600256300001200272490000800284520218000292100002602472700002202498700002102520700002502541700002102566700001702587700002402604700001702628700002102645700002002666700002402686700002402710700002102734700002202755700002102777700001702798700001802815856003602833 2019 eng d a1535-497000aAlbuminuria, Lung Function Decline, and Risk of Incident Chronic Obstructive Pulmonary Disease. The NHLBI Pooled Cohorts Study.0 aAlbuminuria Lung Function Decline and Risk of Incident Chronic O c2019 Feb 01 a321-3320 v1993 a

RATIONALE: Chronic lower respiratory diseases (CLRDs), including chronic obstructive pulmonary disease (COPD) and asthma, are the fourth leading cause of death. Prior studies suggest that albuminuria, a biomarker of endothelial injury, is increased in patients with COPD.

OBJECTIVES: To test whether albuminuria was associated with lung function decline and incident CLRDs.

METHODS: Six U.S. population-based cohorts were harmonized and pooled. Participants with prevalent clinical lung disease were excluded. Albuminuria (urine albumin-to-creatinine ratio) was measured in spot samples. Lung function was assessed by spirometry. Incident CLRD-related hospitalizations and deaths were classified via adjudication and/or administrative criteria. Mixed and proportional hazards models were used to test individual-level associations adjusted for age, height, weight, sex, race/ethnicity, education, birth year, cohort, smoking status, pack-years of smoking, renal function, hypertension, diabetes, and medications.

MEASUREMENTS AND MAIN RESULTS: Among 10,961 participants with preserved lung function, mean age at albuminuria measurement was 60 years, 51% were never-smokers, median albuminuria was 5.6 mg/g, and mean FEV decline was 31.5 ml/yr. For each SD increase in log-transformed albuminuria, there was 2.81% greater FEV decline (95% confidence interval [CI], 0.86-4.76%; P = 0.0047), 11.02% greater FEV/FVC decline (95% CI, 4.43-17.62%; P = 0.0011), and 15% increased hazard of incident spirometry-defined moderate-to-severe COPD (95% CI, 2-31%, P = 0.0021). Each SD log-transformed albuminuria increased hazards of incident COPD-related hospitalization/mortality by 26% (95% CI, 18-34%, P < 0.0001) among 14,213 participants followed for events. Asthma events were not significantly associated. Associations persisted in participants without current smoking, diabetes, hypertension, or cardiovascular disease.

CONCLUSIONS: Albuminuria was associated with greater lung function decline, incident spirometry-defined COPD, and incident COPD-related events in a U.S. population-based sample.

1 aOelsner, Elizabeth, C1 aBalte, Pallavi, P1 aGrams, Morgan, E1 aCassano, Patricia, A1 aJacobs, David, R1 aBarr, Graham1 aBurkart, Kristin, M1 aKalhan, Ravi1 aKronmal, Richard1 aLoehr, Laura, R1 aO'Connor, George, T1 aSchwartz, Joseph, E1 aShlipak, Michael1 aTracy, Russell, P1 aTsai, Michael, Y1 aWhite, Wendy1 aYende, Sachin uhttps://chs-nhlbi.org/node/7980