Albuminuria, lung function decline, and risk of incident chronic obstructive pulmonary disease the NHLBI pooled cohorts study

Elizabeth C. Oelsner*, Pallavi P. Balte, Morgan E. Grams, Patricia A. Cassano, David R. Jacobs, R. Graham Barr, Kristin M. Burkart, Ravi Kalhan, Richard Kronmal, Laura R. Loehr, George T. O’Connor, Joseph E. Schwartz, Michael Shlipak, Russell P. Tracy, Michael Y. Tsai, Wendy White, Sachin Yende

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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 1 decline was 31.5 ml/yr. For each SD increase in log-transformed albuminuria, there was 2.81% greater FEV 1 decline (95% confidence interval [CI], 0.86–4.76%; P = 0.0047), 11.02% greater FEV 1 /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.

Original languageEnglish (US)
Pages (from-to)321-332
Number of pages12
JournalAmerican journal of respiratory and critical care medicine
Issue number3
StatePublished - Feb 1 2019


  • Asthma
  • Epidemiology
  • Spirometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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