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Associations of albuminuria with interstitial lung abnormalities in older community-dwelling adults confounded by age
Journal article   Open access   Peer reviewed

Associations of albuminuria with interstitial lung abnormalities in older community-dwelling adults confounded by age

Faeq Husain-Syed, Indika V. Mallawaarachchi, Gisli Thor Axelsson, Jennie Z. Ma, Catherine L. Debban, Eric A. Hoffman, Claire McGroder, Michaela R. Anderson, Ganesh Raghu, Steven M. Kawut, …
ERJ open research, Vol.11(3), 01221-2024
05/2025
DOI: 10.1183/23120541.01221-2024
PMCID: PMC12183733
PMID: 40551804
url
https://doi.org/10.1183/23120541.01221-2024View
Published (Version of record) Open Access

Abstract

In two population-based cohorts, we did not find an independent relationship between albuminuria and ILA, with age emerging as a key confounding factor. Our results suggest there may be a common systemic pathology of aging that underlies albuminuria and ILA. Background Pulmonary microvascular dysfunction has been suggested to be an early feature of interstitial lung changes, which may precede interstitial lung disease (ILD). The prospective association of albuminuria, a marker of endothelial dysfunction, with interstitial lung abnormalities (ILA) and high-attenuation areas (HAA) remains unexplored. Methods The study included participants with available spot urinary albumin-creatinine ratio (UACR) and CT data for ILA and HAA enrolled in two independent cohorts, MESA (Multi-Ethnic Study of Atherosclerosis; n=2 248) and AGES-Reykjavik (Age, Gene/Environment Susceptibility-Reykjavik; n=3509). HAA were defined as the percentage of imaged lungs with attenuation between −600 and −250 Hounsfield units (MESA only). Regression modeling was performed to assess the associations of UACR with ILA and HAA, adjusted for anthropometric and demographic variables and kidney function. Cox proportional-hazard models were used to examine whether ILA modified the association between albuminuria and all-cause mortality. Results Log-transformed UACR was significantly associated with ILA, with an odds ratio (OR) of 1.21 (95% CI, 1.12–1.30) in MESA and OR 1.13 (95% CI, 1.06–1.21) in AGES-Reykjavik. In multivariable-adjusted models incorporating age, albuminuria was no longer associated with ILA, nor with ILA progression in AGES-Reykjavik. In MESA, higher levels of albuminuria were associated with greater HAA (mean increase of 1.02% per 1-unit increment in log-transformed UACR, 95% CI, 1.01–1.02%), even after adjusting for covariates including age. Albuminuria was more strongly associated with death among those with ILA in MESA but not in AGES-Reykjavik. Conclusions Albuminuria was not associated with ILA after accounting for chronological age. Our findings suggest that there may be a common systemic pathology of aging that underlies albuminuria and interstitial lung changes.

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