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Urinary Kidney Injury Molecule-1 and the Risk of Cardiovascular Mortality in Elderly Men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
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2014 (English)In: Clinical journal of the American Society of Nephrology : CJASN, ISSN 1555-905X, Vol. 9, no 8, 1393-1401 p.Article in journal (Refereed) Published
Abstract [en]

Background and objectives

Kidney injury molecule-1 (KIM-1) has been suggested as a clinically relevant highly specific biomarker of acute kidney tubular damage. However, community-based data on the association between urinary levels of KIM-1 and the risk for cardiovascular mortality are lacking. This study aimed to investigate the association between urinary KIM-1 and cardiovascular mortality.

Design, setting, participants, & measurements

This was a prospective study, using the community-based Uppsala Longitudinal Study of Adult Men (N=590; mean age 77 years; baseline period, 1997–2001; median follow-up 8.1 years; end of follow-up, 2008).

Results

During follow-up, 89 participants died of cardiovascular causes (incidence rate, 2.07 per 100 person-years at risk). Models were adjusted for cardiovascular risk factors (age, systolic BP, diabetes, smoking, body mass index, total cholesterol, HDL cholesterol, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, and history of cardiovascular disease) and for markers of kidney dysfunction and damage (cystatin C–based eGFR and urinary albumin/creatinine ratio). Higher urinary KIM-1/creatinine (from 24-hour urine collections) was associated with a higher risk for cardiovascular mortality (hazard ratio per SD increase, 1.27; 95% confidence interval [95% CI], 1.05 to 1.54; P=0.01). Participants with a combination of high KIM-1/creatinine (upper quintile, ≥175 ng/mmol), low eGFR (≤60 ml/min per 1.73 m2), and microalbuminuria/macroalbuminuria (albumin/creatinine ratio≥3 g/mol) had a >8-fold increased risk compared with participants with low KIM-1/creatinine (<175 ng/mmol), normal eGFR (>60 ml/min per 1.73 m2), and normoalbuminuria (albumin/creatinine ratio<3 g/mol) (hazard ratio, 8.56; 95% CI, 4.17 to 17.56; P<0.001).

Conclusions

These findings suggest that higher urinary KIM-1 may predispose to a higher risk of cardiovascular mortality independently of established cardiovascular risk factors, eGFR, and albuminuria. Additional studies are needed to further assess the utility of measuring KIM-1 in the clinical setting.

Place, publisher, year, edition, pages
2014. Vol. 9, no 8, 1393-1401 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-228731DOI: 10.2215/CJN.11901113ISI: 000339984100010PubMedID: 24923577OAI: oai:DiVA.org:uu-228731DiVA: diva2:734732
Available from: 2014-07-21 Created: 2014-07-21 Last updated: 2016-01-25Bibliographically approved

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Carlsson, Axel CLarsson, AndersHelmersson-Karlqvist, JohannaLind, LarsIngelsson, ErikSundström, JohanÄrnlöv, Johan

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Carlsson, Axel CLarsson, AndersHelmersson-Karlqvist, JohannaLind, LarsIngelsson, ErikSundström, JohanÄrnlöv, Johan
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Molecular epidemiologyScience for Life Laboratory, SciLifeLabBiochemial structure and functionCardiovascular epidemiology
Public Health, Global Health, Social Medicine and EpidemiologyUrology and Nephrology

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