Renal markers and risks of all cause and cardiovascular mortality from the Taichung community based cohort study

Abstract

This study aimed to explore the associations between renal-related and arterial stiffness biomarkers with all-cause and expanded cardiovascular disease (CVD) mortality in a general Taiwanese population. This prospective community-based cohort study included 4883 subjects aged ≥ 20 years who were followed up until December 31, 2016. Renal-related biomarkers consisted of blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR). Arterial stiffness biomarker consisted of brachial-ankle pulse wave velocity (baPWV). The death status of the subjects was ascertained by matching information from death records with the identification number and date of birth of the subjects. Cox proportional hazard models with restricted cubic splines estimated the hazard ratios and 95% confidence intervals for all-cause mortality and expanded CVD mortality. During a mean 8.3 years of follow up, 456 deaths were recorded, 146 of which were due to expanded CVD mortality. The multivariable-adjusted hazard ratios of all-cause mortality was 1.53 (95% CI 1.21–1.94) for BUN (≥ 20 mg/dL vs. < 20 mg/dL), 1.57 (1.15–2.14) for eGFR (< 90 mL/min/1.73 m² vs. ≥ 90 mL/min/1.73 m²), 1.55 (1.25–1.92) for UACR (≥ 30 mg/g vs. < 30 mg/g), and 1.75 (1.14–2.67) for baPWV (≥ 1400 cm/s vs. < 1400 cm/s). The expanded CVD mortality was 1.89 (95% CI 1.30–2.73) for BUN (≥ 20 mg/dL vs. < 20 mg/dL), 2.28 (1.13–4.57) for eGFR (< 90 mL/min/1.73 m² vs. ≥ 90 mL/min/1.73 m²), 2.13 (1.52–2.99) for UACR (≥ 25 mg/g vs. < 25 mg/g), and 15.73 (2.14–115.61) for baPWV (≥ 1400 cm/s vs. < 1400 cm/s). High levels of BUN, UACR, and baPWV and low levels of eGFR showed high risks with all-cause and expanded CVD mortality. Our study provides insights into screening tests to target populations at high risk of premature death due to CVD.