This study was performed as part of the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort study, which is a large-scale, prospective population-based cohort study that commenced in 1997 in Groningen, the Netherlands [17 (link)]. The PREVEND study was primarily aimed to study the utility of urinary albumin excretion as indicator of the future occurrence of renal and cardiovascular diseases. The PREVEND study comprises data on a wealth of parameters that are relevant to cardiorenal diseases. In the period from 1997–1998, 85,421 inhabitants of the city of Groningen aged 28–75 years were contacted and requested to complete a short questionnaire asking information on demographics and history of cardiovascular diseases, as well as to send in a first morning void sample. A total of 40,856 individuals (47.8%) responded, from which 7786 individuals with urinary albumin concentrations (UAC) > 10 mg/L and a randomly selected control group of 3395 individuals with UAC < 10 mg/L were invited to participate in subsequent study screening investigations at the outpatient research clinic of the University Medical Center Groningen (UMCG). This screening program was completed by 8592 participants (n = 6000 with UAC > 10 mg/L and n = 2592 with UAC < 10 mg/L), which together formed the total study cohort. In the period of 2001–2003, a second round of study investigations was organized aiming to collect additional data and biomaterials (e.g., blood, urine) from 6894 of these participants. This second study round served as the baseline for the present study. From this cohort of participants, patients with established CKD defined as having an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (n = 1082) or unknown CKD status (n = 337) were excluded. Furthermore, participants in whom plasma NGAL levels could not be determined (n = 815) due to either missing samples or insufficient sample volumes) were excluded. This resulted in a final sample size of n = 4660 participants for analysis with a study follow-up that ended on 1 January 2011. The PREVEND study was approved by the Institutional Review Board of the UMCG (full name in Dutch: “Medisch Ethische Toetsingscommissie”, abbreviated as “METc”, IRB no. 01/139). All participants provided written informed consent for study participation. The study was conducted according to the principles of the Declaration of Helsinki. The study reporting was in accordance with the EQUATOR guideline: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [18 (link)].
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