Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis

Background Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined. Aim We aimed to determine if proteinuria rema...

Full description

Saved in:
Bibliographic Details
Published inInternational Journal of Stroke Vol. 15; no. 1; pp. 29 - 38
Main Authors Kelly, Dearbhla M, Rothwell, Peter M
Format Book Review Journal Article
LanguageEnglish
Published London, England SAGE Publications 01.01.2020
Subjects
Online AccessGet full text

Cover

Loading…
Abstract Background Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined. Aim We aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure. Summary of review We performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ 2 statistics and I2, and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle–Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63–2.46; p < 0.001) even after adjustment for established cardiovascular risk factors (33 studies; pooled adjusted relative risk 1.72, 1.51–1.95; p < 0.001), albeit with considerable heterogeneity between studies (p < 0.001; I2 = 77.3%). Moreover, the association did not substantially attenuate with more thorough adjustment for hypertension: single baseline blood pressure measure (10 studies; pooled adjusted relative risk = 1.92, 1.39–2.66; p < 0.001); history or treated hypertension (four studies; pooled adjusted relative risk = 1.76, 1.13–2.75, p = 0.013); multiple blood pressure measurements over months to years (four studies; relative risk = 1.68, 1.33–2.14; p < 0.001). Conclusions Even after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors.
AbstractList Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined. We aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure. We performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ statistics and I , and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle-Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63-2.46; p < 0.001) even after adjustment for established cardiovascular risk factors (33 studies; pooled adjusted relative risk 1.72, 1.51-1.95; p < 0.001), albeit with considerable heterogeneity between studies (p < 0.001; I = 77.3%). Moreover, the association did not substantially attenuate with more thorough adjustment for hypertension: single baseline blood pressure measure (10 studies; pooled adjusted relative risk = 1.92, 1.39-2.66; p < 0.001); history or treated hypertension (four studies; pooled adjusted relative risk = 1.76, 1.13-2.75, p = 0.013); multiple blood pressure measurements over months to years (four studies; relative risk = 1.68, 1.33-2.14; p < 0.001). Even after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors.
Background Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined. Aim We aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure. Summary of review We performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ 2 statistics and I2, and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle–Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63–2.46; p < 0.001) even after adjustment for established cardiovascular risk factors (33 studies; pooled adjusted relative risk 1.72, 1.51–1.95; p < 0.001), albeit with considerable heterogeneity between studies (p < 0.001; I2 = 77.3%). Moreover, the association did not substantially attenuate with more thorough adjustment for hypertension: single baseline blood pressure measure (10 studies; pooled adjusted relative risk = 1.92, 1.39–2.66; p < 0.001); history or treated hypertension (four studies; pooled adjusted relative risk = 1.76, 1.13–2.75, p = 0.013); multiple blood pressure measurements over months to years (four studies; relative risk = 1.68, 1.33–2.14; p < 0.001). Conclusions Even after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors.
Author Rothwell, Peter M
Kelly, Dearbhla M
Author_xml – sequence: 1
  givenname: Dearbhla M
  orcidid: 0000-0002-4318-2030
  surname: Kelly
  fullname: Kelly, Dearbhla M
  email: dearbhla.kelly@ndcn.ox.ac.uk
  organization: Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
– sequence: 2
  givenname: Peter M
  surname: Rothwell
  fullname: Rothwell, Peter M
  organization: Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/31935154$$D View this record in MEDLINE/PubMed
BookMark eNpdUMlKBDEQDTLiLHr3JPmB1qRT6XS8yeAGAwou1yadVEvG6YUko8zf24PLwUu9ourV49Wbk0nXd0jIKWfnnCt1wRUo0IJxXWqZs-KAzPajDDToyV8v2JTMY1wzBlKJ4ohMBddCcgkz8voY-oS-2wZvqInUdNR3DgccS5foENB5m_pA-4bGFPp3vKRPu5iwNclbGvDD4-d45WiLyWSmM5td9PGYHDZmE_HkBxfk5eb6eXmXrR5u75dXq8xKxlLmONOgmEIJ4BqGUltoytwWruR5XeumBCslNJxZBeW4FsbkUEPh8oJrVYoFOfvWHbZ1i64agm9N2FW_D46E7JsQzRtW634bRoex4qzaB1j9D1B8AcDMYbo
CitedBy_id crossref_primary_10_3389_fendo_2020_559446
crossref_primary_10_7759_cureus_58311
crossref_primary_10_1053_j_ajkd_2023_07_023
crossref_primary_10_1016_j_jstrokecerebrovasdis_2021_105730
crossref_primary_10_1161_JAHA_123_030131
crossref_primary_10_3390_jpm13121662
crossref_primary_10_1136_svn_2020_000422
crossref_primary_10_1186_s40001_023_01087_6
crossref_primary_10_1016_j_heliyon_2024_e26110
crossref_primary_10_1016_j_diabres_2022_110090
crossref_primary_10_1016_j_jocn_2022_05_011
crossref_primary_10_2147_DDDT_S333209
crossref_primary_10_3349_ymj_2022_63_1_66
crossref_primary_10_1038_s41598_022_16690_6
crossref_primary_10_1212_WNL_0000000000200153
crossref_primary_10_3390_biomedicines11092398
crossref_primary_10_12677_ACM_2022_125545
crossref_primary_10_1007_s00415_023_12171_6
crossref_primary_10_1161_CIR_0000000000001209
crossref_primary_10_1111_nep_14049
crossref_primary_10_3389_fneur_2022_830064
crossref_primary_10_1093_eurheartj_ehae153
crossref_primary_10_1161_CIR_0000000000001123
crossref_primary_10_1161_CIR_0000000000001052
crossref_primary_10_1212_WNL_0000000000207852
crossref_primary_10_1093_ndt_gfae079
crossref_primary_10_1177_1747493020975250
ContentType Book Review
Journal Article
Copyright 2020 World Stroke Organization
Copyright_xml – notice: 2020 World Stroke Organization
DBID AFRWT
CGR
CUY
CVF
ECM
EIF
NPM
DOI 10.1177/1747493019895206
DatabaseName Sage Journals GOLD Open Access 2024
Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
DatabaseTitleList MEDLINE

Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
– sequence: 3
  dbid: AFRWT
  name: SAGE Open Access
  url: http://journals.sagepub.com/
  sourceTypes: Publisher
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1747-4949
EndPage 38
ExternalDocumentID 31935154
10.1177_1747493019895206
Genre Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Journal Article
GrantInformation_xml – fundername: Wellcome Trust
– fundername: Department of Health
– fundername: British Heart Foundation
GroupedDBID ---
-TM
.3N
.GA
.Y3
05W
0R~
10A
1OC
26-
29J
31~
4.4
50Y
50Z
52M
52O
52S
52T
52W
53G
54M
5GY
5HH
5VS
702
7PT
8-0
8-1
8-3
8-4
8-5
930
A01
A03
AABMB
AACMV
AADUE
AAEVG
AAEWN
AAGMC
AAHHS
AAJPV
AAKGS
AAONW
AARDL
AARIX
AATAA
AATBZ
AAUAS
ABAWP
ABCCA
ABEIX
ABFWQ
ABJNI
ABKRH
ABLUO
ABNCE
ABPNF
ABPVW
ABQNX
ABQXT
ABRHV
ABVFX
ABXGC
ACARO
ACBWZ
ACCFJ
ACDSZ
ACDXX
ACFEJ
ACGFO
ACGFS
ACGZU
ACJTF
ACLFY
ACOFE
ACOXC
ACPRK
ACROE
ACSIQ
ACTQU
ACUAV
ACUIR
ACXKE
ACXMB
ACXQS
ADBBV
ADIZJ
ADRRZ
ADZOD
ADZZY
AECGH
AEEZP
AEIMD
AENEX
AEPTA
AEQDE
AEQLS
AESZF
AEUHG
AEUIJ
AEWDL
AEWHI
AEXNY
AFBPY
AFEET
AFKRG
AFMOU
AFQAA
AFRWT
AFUIA
AGKLV
AGNHF
AGWFA
AHMBA
AIOMO
AIWBW
AJAOE
AJBDE
AJUZI
AJXAJ
ALAGY
ALMA_UNASSIGNED_HOLDINGS
ALTZF
AMBMR
AMCVQ
ARTOV
ATUGU
AUTPY
AYAKG
AZBYB
B8M
BAFTC
BBRGL
BDDNI
BDRZF
BFHJK
BKIIM
BKSCU
BPACV
BROTX
BRXPI
BSEHC
BWJAD
CAG
CDWPY
CFDXU
COF
CS3
D-6
D-7
D-E
D-F
DC-
DC.
DCZOG
DOPDO
DPXWK
DU5
DV7
EBS
EJD
EMOBN
ESX
F00
F01
F04
F21
F5P
FEDTE
FHBDP
G-S
G.N
GODZA
GROUPED_SAGE_PREMIER_JOURNAL_COLLECTION
H.X
HF~
HOLLA
HVGLF
HZ~
J8X
JCYGO
K.F
LH4
LP6
LP7
LW6
M4V
MK4
N04
N05
NF~
O9-
OIG
OVD
P2P
P2X
P2Z
P4B
P4D
PQQKQ
Q.N
QB0
R.K
ROL
RX1
SCNPE
SFC
SHG
SPQ
SPV
SUPJJ
TEORI
UB1
V8K
W8V
W99
WYUIH
XG1
ZONMY
ZPPRI
ZRKOI
ZSSAH
~IA
~WT
ACJER
ALKWR
ANDLU
CGR
CUY
CVF
ECM
EIF
H13
NPM
ID FETCH-LOGICAL-c500t-d1094707e544df0e59c4f82c6d812bb9f84c554f10c748e593aa24b46d2619783
IEDL.DBID AFRWT
ISSN 1747-4930
IngestDate Sat Sep 28 08:35:59 EDT 2024
Tue Jul 16 20:52:08 EDT 2024
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 1
Keywords albuminuria
Chronic kidney disease
glomerular filtration rate
stroke
hypertension
proteinuria
Language English
License This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c500t-d1094707e544df0e59c4f82c6d812bb9f84c554f10c748e593aa24b46d2619783
ORCID 0000-0002-4318-2030
OpenAccessLink https://journals.sagepub.com/doi/full/10.1177/1747493019895206?utm_source=summon&utm_medium=discovery-provider
PMID 31935154
PageCount 10
ParticipantIDs pubmed_primary_31935154
sage_journals_10_1177_1747493019895206
PublicationCentury 2000
PublicationDate 20200100
2020-01-00
PublicationDateYYYYMMDD 2020-01-01
PublicationDate_xml – month: 1
  year: 2020
  text: 20200100
PublicationDecade 2020
PublicationPlace London, England
PublicationPlace_xml – name: London, England
– name: United States
PublicationTitle International Journal of Stroke
PublicationTitleAlternate Int J Stroke
PublicationYear 2020
Publisher SAGE Publications
Publisher_xml – name: SAGE Publications
References Rajpal, Alshawabkeh, Almaddah 2018; 3
Ito, Nagasawa, Abe, Mori 2009; 32
Mykkänen, Zaccaro, O’Leary, Howard, Robbins, Haffner 1997; 28
Greenberg 2006; 354
Wachtell, Olsen, Dahlof 2002; 20
Valmadrid, Klein, Moss, Klein 2000; 160
Diercks, van Boven, Hillege 2000; 21
McAlister, Wiebe, Jun 2017; 33
Bello, Hemmelgarn, Lloyd 2011; 6
Kramer, Jacobs, Bild 2005; 46
Messerli, Rimoldi, Bangalore 2018; 39
Ninomiya, Perkovic, Verdon 2009; 53
de Zeeuw, Parving, Henning 2006; 17
Shekhar, Liu, Travis, Roman, Fan 2017; 2017
Azar, Tobian, Johnson 1974; 227
Matsushita, Coresh, Sang 2015; 3
Inscho, Cook, Murzynowski, Imig 2004; 22
Sandsmark, Messe, Zhang 2015; 46
White, Yu, Craig, Polkinghorne, Atkins, Chadban 2011; 58
Stehouwer, Smulders 2006; 17
Masson, Webster, Hong, Turner, Lindley, Craig 2015; 30
Deckert, Feldt-Rasmussen, Borch-Johnsen, Jensen, Kofoed-Enevoldsen 1989; 32
Ibsen, Olsen, Wachtell 2005; 45
Ruilope, Zanchetti, Julius 2007; 25
Kelly, Rothwell 2019; 50
Levey, Stevens 2010; 55
Haas, Aragam, Emdin 2018; 103
References_xml – volume: 33
  start-page: 243
  year: 2017
  end-page: 252
  article-title: Are existing risk scores for nonvalvular atrial fibrillation useful for prediction or risk adjustment in patients with chronic kidney disease?
  publication-title: Can J Cardiol
  contributor:
    fullname: Jun
– volume: 53
  start-page: 417
  year: 2009
  end-page: 425
  article-title: Proteinuria and stroke: a meta-analysis of cohort studies
  publication-title: Am J Kidney Dis
  contributor:
    fullname: Verdon
– volume: 50
  start-page: 3085
  issue: 11
  year: 2019
  end-page: 3092
  article-title: Does Chronic Kidney Disease Predict Stroke Risk Independent of Blood Pressure?: A Systematic Review and Meta-Regression
  publication-title: Stroke
  contributor:
    fullname: Rothwell
– volume: 354
  start-page: 1451
  year: 2006
  end-page: 1453
  article-title: Small vessels, big problems
  publication-title: N Engl J Med
  contributor:
    fullname: Greenberg
– volume: 17
  start-page: 2100
  year: 2006
  end-page: 2105
  article-title: Microalbuminuria as an early marker for cardiovascular disease
  publication-title: J Am Soc Nephrol
  contributor:
    fullname: Henning
– volume: 20
  start-page: 405
  year: 2002
  end-page: 412
  article-title: Microalbuminuria in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study
  publication-title: J Hypertens
  contributor:
    fullname: Dahlof
– volume: 103
  start-page: 461
  year: 2018
  end-page: 473
  article-title: Genetic association of albuminuria with cardiometabolic disease and blood pressure
  publication-title: Am J Human Genet
  contributor:
    fullname: Emdin
– volume: 22
  start-page: 811
  issue: 4
  year: 2004
  end-page: 818
  article-title: Elevated arterial pressure impairs autoregulation independently of AT(1) receptor activation
  publication-title: J Hypertens
  contributor:
    fullname: Imig
– volume: 21
  start-page: 1922
  year: 2000
  end-page: 1927
  article-title: Microalbuminuria is independently associated with ischaemic electrocardiographic abnormalities in a large non-diabetic population. The PREVEND (Prevention of REnal and Vascular ENdstage Disease) study
  publication-title: Eur Heart J
  contributor:
    fullname: Hillege
– volume: 46
  start-page: 2075
  year: 2015
  end-page: 2080
  article-title: Proteinuria, but not eGFR, predicts stroke risk in chronic kidney disease: chronic renal insufficiency cohort study
  publication-title: Stroke
  contributor:
    fullname: Zhang
– volume: 3
  start-page: 308
  year: 2018
  end-page: 316
  article-title: Association of albuminuria with major adverse outcomes in adults with congenital heart disease: results from the Boston Adult Congenital Heart Biobank
  publication-title: JAMA Cardiol
  contributor:
    fullname: Almaddah
– volume: 227
  start-page: 1045
  year: 1974
  end-page: 1050
  article-title: Glomerular, efferent arteriolar, peritubular capillary, and tubular pressures in hypertension
  publication-title: Am J Physiol
  contributor:
    fullname: Johnson
– volume: 28
  start-page: 1710
  issue: 9
  year: 1997
  end-page: 1716
  article-title: Microalbuminuria and carotid artery intima-media thickness in nondiabetic and NIDDM subjects. The Insulin Resistance Atherosclerosis Study (IRAS)
  publication-title: Stroke
  contributor:
    fullname: Haffner
– volume: 32
  start-page: 115
  issue: 2
  year: 2009
  end-page: 121
  article-title: Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk
  publication-title: Hypertens Res
  contributor:
    fullname: Mori
– volume: 39
  start-page: 2241
  year: 2018
  end-page: 2242
  article-title: Changing definition of hypertension in guidelines: how innocent a number game?
  publication-title: Eur Heart J
  contributor:
    fullname: Bangalore
– volume: 45
  start-page: 198
  year: 2005
  end-page: 202
  article-title: Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: Losartan Intervention for Endpoint Reduction in Hypertension study
  publication-title: Hypertension
  contributor:
    fullname: Wachtell
– volume: 46
  start-page: 38
  year: 2005
  end-page: 43
  article-title: Urine albumin excretion and subclinical cardiovascular disease. The Multi-Ethnic Study of Atherosclerosis
  publication-title: Hypertension
  contributor:
    fullname: Bild
– volume: 17
  start-page: 2106
  year: 2006
  end-page: 2111
  article-title: Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms
  publication-title: J Am Soc Nephrol
  contributor:
    fullname: Smulders
– volume: 30
  start-page: 1162
  issue: 7
  year: 2015
  end-page: 1169
  article-title: Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis
  publication-title: Nephrol Dial Transplant
  contributor:
    fullname: Craig
– volume: 160
  start-page: 1093
  issue: 8
  year: 2000
  end-page: 1100
  article-title: The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus
  publication-title: Arch Intern Med
  contributor:
    fullname: Klein
– volume: 2017
  start-page: 21
  issue: 1
  year: 2017
  end-page: 27
  article-title: Cerebral autoregulation in hypertension and ischemic stroke: a mini review
  publication-title: J Pharm Sci Exp Pharmacol
  contributor:
    fullname: Fan
– volume: 3
  start-page: 514
  year: 2015
  end-page: 525
  article-title: Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data
  publication-title: Lancet Diabetes Endocrinol
  contributor:
    fullname: Sang
– volume: 32
  start-page: 219
  issue: 4
  year: 1989
  end-page: 226
  article-title: Albuminuria reflects widespread vascular damage. The Steno hypothesis
  publication-title: Diabetologia
  contributor:
    fullname: Kofoed-Enevoldsen
– volume: 58
  start-page: 19
  issue: 1
  year: 2011
  end-page: 28
  article-title: Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community
  publication-title: Am J Kidney Dis
  contributor:
    fullname: Chadban
– volume: 25
  start-page: 1473
  year: 2007
  end-page: 1479
  article-title: Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial
  publication-title: J Hypertens
  contributor:
    fullname: Julius
– volume: 6
  start-page: 1418
  year: 2011
  end-page: 1426
  article-title: Associations among estimated glomerular filtration rate, proteinuria, and adverse cardiovascular outcomes
  publication-title: Clin J Am Soc Nephrol
  contributor:
    fullname: Lloyd
– volume: 55
  start-page: 622
  year: 2010
  end-page: 627
  article-title: Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions
  publication-title: Am J Kidney Dis
  contributor:
    fullname: Stevens
SSID ssj0045736
Score 2.3985772
SecondaryResourceType review_article
Snippet Background Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as...
Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the...
SourceID pubmed
sage
SourceType Index Database
Publisher
StartPage 29
SubjectTerms Comorbidity
Humans
Predictive Value of Tests
Proteinuria - epidemiology
Stroke - epidemiology
Title Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis
URI https://journals.sagepub.com/doi/full/10.1177/1747493019895206
https://www.ncbi.nlm.nih.gov/pubmed/31935154
Volume 15
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3NT8IwFH9BSIye_BY_SA_GW2Vs7bp5McZIiAmEKCi3Zeu6hBgGge3gf-97bEOiF69L1zbvtX3fvwdwI9xYhsoW3E6cmAvPaO5JhVarihyP4EbckPyQ_YHbG4uXiZzUIK1qYUoKru4orQp3tH6s6XaTN7pdBhnbqEYr4ePZ9D1f2pb7kGezoPB2V0016AuFp_MZRbY15UN-8aq6bQcatkJBVYfGY_f1Y1S93UKqdVNBmp_TAj-BzT9rbomsrRywtVjqHsA-lSqwwr9_CDWTHsFuv4yWH8P7kEAYpmmOh4yFKxambLrpepuxxZJGos3N5glbZcv5p7lnbxtkZ1ZUteBfMZuZLORhiV9yAuPu8-ipx8s-ClxLy8p43EEbTlnKSCHixDLS1yLxbO3GKN2jyE88oVGrSDqWVsgt6TthaIsI2UjmlfKcU6in89ScA1Oyk2iBEk1RAayvIuk6QkpjGe0nqE024awgSrAowDICvOIO6kyiCbdEpaBicNApgcZ_0_XivwMvYc8m43ftD7mCerbMzTVqCFnUKtnagp3BsP8N7ju0qA
link.rule.ids 313,780,784,792,21966,27853,27922,27925,44945,45333
linkProvider SAGE Publications
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3JTsMwELUQlVhO7JTVB8TNKMs4jrkhRFWgrRC00FvkOLZUIdKqTf-fcZKWCi7cx1H0ZuxZ7HlDyBVEGVciABbYMGMQG81iLjBrFWkYO7qRSLk6ZLcXtQfwNOTDlVFfNYKzG_esCv-oPKyXu9v1iWP8CxLNUsaSB45suwEYsqCJN-5arx_9xTEMXJTzAZ08cwt-7ij_fGPF-6w85yo9TGuHbLuuA1qV6nfJmsn3yEa3vvjeJ-8vjk9hlM_RXqiaUZXT0XKAbUEnUyeJ6TMdWzorpuNPc0vfliTNtGpQwVUZ_TKFYqqmIjkgg9ZD_77N6pEITHPPK1jmYzomPGE4QGY9w6UGGwc6ytBRp6m0MWgMEKzvaYHAcxkqFUCKGnGZkojDQ7Kej3NzTKjgvtWAzkm4XlYpUh6FwLnxjJYWA8MmOapASSYV70WCuzXE8Aea5NqhlCx0lfg1Z_hvXE_-K3hJNtv9bifpPPaeT8lW4HLassxxRtaL6dyco-Mv0otaxd_WWKD-
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3NT8IwFG8MJERPfoufPRhvlbG9rqs3oy74ASEKym3ZujYhxkFg_P--bgOJXry_Ns17bd_37xFyCX7KY-ECc42XMgi0YgEX6LWKxAss3Igf2zhkt-d3hvA04qOqNsf2wlQcnF_bsio8UfFZ29c9TU2ryjG20IoWIPFqykBy1wJu1wEk8Bqp34avH4PlVwxcFDMCLT2zC37ylH_2WNNAayVdhZYJt8mW7TygZbh-h2zobJc0ulXye4-89y2mwjhb4J2h8ZzGGR2vhtjmdDqzlOhC04mh83w2-dQ39G0F1EzLJhVcldIvnccsruBI9skwfBjcdVg1FoEp7jg5S9vokglHaA6QGkdzqcAErvJTVNZJIk0ACo0E03aUQOZz6cWxCwlKxXpLIvAOSC2bZPqIUMHbRgEqKGH7WaVIuO8B59rRSho0DpvksGRKNC2xLyJ8sR6aQNAkV5ZL0VJeUbvCDf_N1-P_El6QRv8-jF4ee88nZNO1bm0R6TgltXy20Geo-_PkvJLwN41bohc
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Proteinuria+as+an+independent+predictor+of+stroke%3A+Systematic+review+and+meta-analysis&rft.jtitle=International+Journal+of+Stroke&rft.au=Kelly%2C+Dearbhla+M&rft.au=Rothwell%2C+Peter+M&rft.date=2020-01-01&rft.pub=SAGE+Publications&rft.issn=1747-4930&rft.eissn=1747-4949&rft.volume=15&rft.issue=1&rft.spage=29&rft.epage=38&rft_id=info:doi/10.1177%2F1747493019895206&rft.externalDocID=10.1177_1747493019895206
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1747-4930&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1747-4930&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1747-4930&client=summon