A Structured Review of the Relationship Between Microalbuminuria and Cardiovascular Events in Patients with Diabetes Mellitus and Hypertension

Park, Hayley Y; Schumock, Glen T.; Pickard, A. Simon; Akhras, Kasem

doi:10.1592/phco.23.15.1611.31962

Cited by 29 publications

(14 citation statements)

References 43 publications

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“…GFR was calculated by the Schwartz formula with less than 90ml / minute / 1.73 m 2 was classified as an abnormal value (10)(11)(12). Hypertension was defined as blood pressure higher than the 95th percentile for age and sex (9,10,13). Urine measurements at follow-up were made using first morning specimens.…”

Section: Methodsmentioning

confidence: 99%

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

et al. 2008

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Prior long-term retrospective studies have described renal sequelae in 25-50 % of post diarrheal hemolytic uremic syndrome (D+HUS ) survivors, but the ability to predict the likelihood of chronic renal related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who had survived an acute episode of D+HUS and were without end stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least one year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least one day of oliguria, with 69 individuals having had at least one day of anuria. Incidence of renal related sequelae (proteinuria, low glomerular filtration rate [GFR], and hypertension) were determined among experimental groups based on the duration of oliguria and anuria. One or more sequelae (e.g. proteinuria, low GFR, hypertension) were seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria; with anuria being a better predictor of most related sequelae than oliguria. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison to those with no anuria (OR = 12.8; 95% CI = 2.9 to 57.5). Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR = 35.2; 95% CI = 5.1 to 240.5). These findings may help to identify children who need periodic and extended follow-up after discharge from the hospital.

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Section: Methodsmentioning

confidence: 99%

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

et al. 2008

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“…Development of albuminuria in patients with diabetes is believed to increase the risk for cardiovascular events by two to eight times (35,36), through mechanisms that could involve low-grade inflammation, ED, and impaired insulin sensitivity (10,(37)(38)(39). Of note, a recent placebo-controlled study of patients with type 2 diabetes showed that insulin sensitizers (thiazolidinediones) not only decreased UAE but also enhanced insulin sensitivity and decreased circulating TNF-␣ levels (40).…”

Section: Ptx3 and Proteinuria In Patients With Type 2 Diabetesmentioning

confidence: 99%

Novel Links between the Long Pentraxin 3, Endothelial Dysfunction, and Albuminuria in Early and Advanced Chronic Kidney Disease

Suliman¹,

Yılmaz²,

Carrero³

et al. 2008

Clinical Journal of the American Society of Nephrology

114

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Background and objectives: Albuminuria and inflammation predict cardiovascular events. Pentraxin 3, an inflammatory mediator produced by, among others, endothelial cells, may have a role in atherogenesis.Design, setting, participants, & measurements: In 207 Swedish patients with stage 5 chronic kidney disease and 79 Turkish patients with type 2 diabetes and proteinuria and normal renal function, whether serum pentraxin 3 levels are associated with albuminuria and endothelial dysfunction was studied.Results: Patients with stage 5 chronic kidney disease and a high degree of albuminuria more often had diabetes and higher levels of pentraxin 3, vascular cellular adhesion molecule-1, and blood pressure. Moreover, pentraxin 3 was independently associated with 24-h urinary albumin excretion. In patients with type 2 diabetes, pentraxin 3 was significantly higher than in control subjects. Patients with type 2 diabetes and more proteinuria had higher pentraxin 3, C-reactive protein, glycosylated hemoglobin, insulin, and homeostasis model assessment index as well as lower flow-mediated dilation and serum albumin. Pentraxin 3 was positively correlated with C-reactive protein, homeostasis model assessment index, and carotid intima-media thickness and negatively with flow-mediated dilation. Pentraxin 3 and glomerular filtration rate were independently associated with 24-h urinary protein excretion. Only pentraxin 3 and proteinuria were significantly and independently associated with flow-mediated dilation.Conclusions: In two different renal cohorts, one of stage 5 chronic kidney disease and one of type 2 diabetes and normal renal function, pentraxin 3 was independently associated with proteinuria. Moreover, both pentraxin 3 and proteinuria were associated with endothelial dysfunction in patients with type 2 diabetes.

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“…Greater recent attention has been paid to describing this association in patients with type 2 diabetes [5,6,8,9,43]. A 10-year observational follow-up study of 939 adults with type 1 diabetes at the Steno Diabetes Centre showed that microalbuminuria predicted cardiovascular mortality independently of classical risk factors, with relative risk (95% confidence interval) of 1.45 (1.18-1.77) [3,4].…”

Section: Microalbuminuria Predicts Cardiovascular Events In Patients mentioning

confidence: 99%

What is the evidence that microalbuminuria is a predictor of cardiovascular disease events?

Yuyun

Adler

Wareham

2005

Current Opinion in Nephrology and Hypertension

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Future absolute risk prediction scores for primary cardiovascular events could include microalbuminuria as a modifiable risk factor. The association between levels of albuminuria and cardiovascular outcomes in individuals within the normoalbuminuric range questions the current categorical definition of microalbuminuria. Intensive multifactorial interventions, including the use of agents that affect the renin-angiotensin pathway, are effective in reducing cardiovascular risk in patients with microalbuminuria and diabetes or hypertension.

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A Structured Review of the Relationship Between Microalbuminuria and Cardiovascular Events in Patients with Diabetes Mellitus and Hypertension

Cited by 29 publications

References 43 publications

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Novel Links between the Long Pentraxin 3, Endothelial Dysfunction, and Albuminuria in Early and Advanced Chronic Kidney Disease

What is the evidence that microalbuminuria is a predictor of cardiovascular disease events?

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