Elevated albuminuria may be associated with subsequent mortality from chronic lower respiratory disease and from influenza and pneumonia, independent of diabetes or chronic kidney disease, according to the results of a longitudinal analysis published in the Annals of the American Thoracic Society.

It is unclear whether albuminuria, a marker of endothelial dysfunction, is an early predictor of mortality from chronic lower respiratory disease and from influenza and pneumonia; therefore, researchers analyzed data from 7944 participants aged 40 years and older from the National Health and Nutrition Examination Survey conducted between 1988 and 1994 (NHANES III) to evaluate this association.

The average follow-up time was 19.2 years and during this time, 200 participants died of chronic lower respiratory disease and 129 died of influenza or pneumonia. Albuminuria was within the normal range (albumin/creatinine ratio <30 mg/g) in 89.1% of participants, moderately increased (albumin/creatinine ratio between 30 and <300 mg/g) in 9.4% of participants, and severely increased (albumin/creatinine ratio ≥300 mg/g) in 1.6% of participants.


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A 10-fold increase in albuminuria was associated with an 88% higher mortality risk from chronic lower respiratory disease, after adjusting for covariates, including comorbidities. In sensitivity analyses, the results remained statistically significant after excluding participants with baseline chronic lower respiratory disease, diabetes, or chronic kidney disease. A 10-fold increase in albuminuria was also associated with a 103% increase in mortality risk from influenza and pneumonia, and these results remained statistically significant after excluding participants with baseline chronic lower respiratory disease, diabetes, or chronic kidney disease.

“Future prospective studies with repeated measures of albuminuria and covariates are warranted to confirm these findings,” the study authors concluded. “Further research is also needed to investigate whether preventive measures targeting individuals with high albuminuria levels might help prevent mortality from [chronic lower respiratory disease] and from influenza and pneumonia.”

Reference

Mendy A, Salo PM, Wilkerson J, et al. Albuminuria as a predictor of mortality from chronic lower respiratory disease and from influenza and pneumonia. Ann Am Thorac Soc. Published on May 12, 2021. doi:10.1513/AnnalsATS.202009-1226RL