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    Proteinuria and Stroke: A Meta-analysis of Cohort Studies

    Access Status
    Fulltext not available
    Authors
    Ninomiya, T.
    Perkovic, V.
    Verdon, C.
    Barzi, F.
    Cass, A.
    Gallagher, M.
    Jardine, M.
    Anderson, C.
    Chalmers, J.
    Craig, J.
    Huxley, Rachel
    Date
    2009
    Type
    Journal Article
    
    Metadata
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    Citation
    Ninomiya, T. and Perkovic, V. and Verdon, C. and Barzi, F. and Cass, A. and Gallagher, M. and Jardine, M. et al. 2009. Proteinuria and Stroke: A Meta-analysis of Cohort Studies. American Journal of Kidney Diseases. 53 (3): pp. 417-425.
    Source Title
    American Journal of Kidney Diseases
    DOI
    10.1053/j.ajkd.2008.08.032
    ISSN
    0272-6386
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/10159
    Collection
    • Curtin Research Publications
    Abstract

    Background: The associations between decreased kidney function and cardiovascular disease recently have been established. However, there is uncertainty about the consistency between the independent associations of proteinuria as a risk factor across all cardiovascular end points. We undertook a meta-analysis of published cohort studies to provide a reliable estimate of the strength of association between proteinuria and risk of stroke. Study Design: Meta-analysis of observational cohort studies. Setting & Population: General population of participants with diabetes. Studies were excluded if participants had known glomerular disease or had undergone dialysis or transplantation. Selection Criteria for Studies: MEDLINE, EMBASE, and CINAHL databases were searched for studies that reported age- or multivariate-adjusted risk ratio with some estimate of the variance of the association between proteinuria and risk of stroke, without language restriction. Factor: Proteinuria or albuminuria. Outcomes: Fatal or nonfatal stroke. Results: Data from 10 published studies involving 140,231 participants and 3,266 strokes were eligible for inclusion. Participants with proteinuria had a 71% greater risk of stroke compared with those without proteinuria (95% confidence interval, 1.39 to 2.10). There was evidence of significant quantitative heterogeneity in the magnitude of the association across studies (I2 = 60%; P for heterogeneity = 0.008), which was partially explained by differences in methods for measuring proteinuria. The risk of stroke remained significant after adjustment for other vascular risk factors. Limitations: Because individual patient data were unavailable, we were unable to fully examine the impact of adjustment for known cardiovascular risk factors on the strength of the association between proteinuria and stroke risk. It is possible that the pooled estimate was affected by regression dilution bias. Conclusions: These findings support the independent relationship between proteinuria and stroke. Additional studies are warranted to determine whether interventions to reduce proteinuria are effective at reducing rates of stroke. © 2009 National Kidney Foundation, Inc.

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