Dipstick proteinuria predicts all-cause mortality in general population: A study of 17 million Korean adults

Yeongkeun Kwon, Kyungdo Han, Yang-Hyun Kim, Sungsoo Park, Do-Hoon Kim, Yong Kyun Roh, Yong Gyu Park, Kyung-Hwan Cho

Research output: Contribution to journalArticle

Abstract

Objective A quantitative basis for the use of dipstick urinalysis for risk assessment of all-cause mortality is scarce. Therefore, we investigated the association between dipstick proteinuria and all-cause mortality in a general population and evaluated the effect of confounders on this association. Methods The study population included 17,342,956 adults who underwent health examinations between 2005 and 2008 under the National Health Insurance System. Proteinuria was determined using a single dipstick urinalysis, and the primary outcome of this study was all-cause mortality. The prognostic impact of proteinuria was assessed by constructing a multivariable Cox model. Results The mean age of the study population (53.24% male) was 46.06 years; 724,681 deaths from all causes occurred over a median follow-up period of 9.34 years (interquartile range 8.17–10.16), and the maximum follow-up was 12.12 years. After full adjustment for covariates, a higher level of dipstick proteinuria indicated a higher risk of all-cause death [Hazard ratios (95% confidence intervals); 1.22 (1.20–1.24), 1.47 (1.45–1.49), 1.81 (1.77–1.84), 2.32 (2.24–2.41), 2.74 (2.54–2.96); trace to 4+, respectively], and various subgroup analyses did not affect the main outcome for the total population. 1+ proteinuria in the group without metabolic diseases (hypertension, diabetes, dyslipidemia, or obesity) resulted in higher hazard ratios than those in the group with metabolic diseases and negative or trace proteinuria. Conclusions Our study showed a strong association between dipstick proteinuria and all-cause mortality in this nationwide population-based cohort in South Korea.

Original languageEnglish
Article numbere0199913
JournalPLoS One
Volume13
Issue number6
DOIs
Publication statusPublished - 2018 Jun 1

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Proteinuria
Hazards
Health insurance
Mortality
Medical problems
Risk assessment
Population
Health
Urinalysis
urinalysis
Metabolic Diseases
metabolic diseases
Cause of Death
death
health insurance
Republic of Korea
National Health Programs
South Korea
hyperlipidemia
Dyslipidemias

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Dipstick proteinuria predicts all-cause mortality in general population : A study of 17 million Korean adults. / Kwon, Yeongkeun; Han, Kyungdo; Kim, Yang-Hyun; Park, Sungsoo; Kim, Do-Hoon; Roh, Yong Kyun; Park, Yong Gyu; Cho, Kyung-Hwan.

In: PLoS One, Vol. 13, No. 6, e0199913, 01.06.2018.

Research output: Contribution to journalArticle

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N2 - Objective A quantitative basis for the use of dipstick urinalysis for risk assessment of all-cause mortality is scarce. Therefore, we investigated the association between dipstick proteinuria and all-cause mortality in a general population and evaluated the effect of confounders on this association. Methods The study population included 17,342,956 adults who underwent health examinations between 2005 and 2008 under the National Health Insurance System. Proteinuria was determined using a single dipstick urinalysis, and the primary outcome of this study was all-cause mortality. The prognostic impact of proteinuria was assessed by constructing a multivariable Cox model. Results The mean age of the study population (53.24% male) was 46.06 years; 724,681 deaths from all causes occurred over a median follow-up period of 9.34 years (interquartile range 8.17–10.16), and the maximum follow-up was 12.12 years. After full adjustment for covariates, a higher level of dipstick proteinuria indicated a higher risk of all-cause death [Hazard ratios (95% confidence intervals); 1.22 (1.20–1.24), 1.47 (1.45–1.49), 1.81 (1.77–1.84), 2.32 (2.24–2.41), 2.74 (2.54–2.96); trace to 4+, respectively], and various subgroup analyses did not affect the main outcome for the total population. 1+ proteinuria in the group without metabolic diseases (hypertension, diabetes, dyslipidemia, or obesity) resulted in higher hazard ratios than those in the group with metabolic diseases and negative or trace proteinuria. Conclusions Our study showed a strong association between dipstick proteinuria and all-cause mortality in this nationwide population-based cohort in South Korea.

AB - Objective A quantitative basis for the use of dipstick urinalysis for risk assessment of all-cause mortality is scarce. Therefore, we investigated the association between dipstick proteinuria and all-cause mortality in a general population and evaluated the effect of confounders on this association. Methods The study population included 17,342,956 adults who underwent health examinations between 2005 and 2008 under the National Health Insurance System. Proteinuria was determined using a single dipstick urinalysis, and the primary outcome of this study was all-cause mortality. The prognostic impact of proteinuria was assessed by constructing a multivariable Cox model. Results The mean age of the study population (53.24% male) was 46.06 years; 724,681 deaths from all causes occurred over a median follow-up period of 9.34 years (interquartile range 8.17–10.16), and the maximum follow-up was 12.12 years. After full adjustment for covariates, a higher level of dipstick proteinuria indicated a higher risk of all-cause death [Hazard ratios (95% confidence intervals); 1.22 (1.20–1.24), 1.47 (1.45–1.49), 1.81 (1.77–1.84), 2.32 (2.24–2.41), 2.74 (2.54–2.96); trace to 4+, respectively], and various subgroup analyses did not affect the main outcome for the total population. 1+ proteinuria in the group without metabolic diseases (hypertension, diabetes, dyslipidemia, or obesity) resulted in higher hazard ratios than those in the group with metabolic diseases and negative or trace proteinuria. Conclusions Our study showed a strong association between dipstick proteinuria and all-cause mortality in this nationwide population-based cohort in South Korea.

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