Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion

Brantsma, Auke H.; Bakker, Stephan J. L.; Hillege, Hans L.; Zeeuw, Dick de; Jong, Paul E. de; Gansevoort, Ronald

doi:10.1093/ndt/gfn356

Cited by 153 publications

(118 citation statements)

References 27 publications

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“…In the earlier stage of CKD, evaluation of albuminuria and renal function, as well as therapeutic intervention, may be important to prevent future development and progression of CVD, in addition to the development and progression of CKD. [33][34][35] These results thus revealed that CKD is significantly related to MHT and WCHT on the basis of ABP monitoring in the general population. Further prospective studies are needed to clarify the role of ABP measurements in predicting future occurrence of CKD and associated disorders in the general population.…”

Section: Usefulness Of Ambulatory Blood Pressure Monitoring In Ckdmentioning

confidence: 88%

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

et al. 2010

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Masked hypertension (MHT) is considered to be associated with organ damage, whereas the association of white-coat hypertension (WCHT) with organ damage remains controversial. Using home blood pressure measurements, we have previously reported that MHT is associated with a risk of chronic kidney disease (CKD) compared with sustained normal blood pressure (SNBP), although WCHT was not significantly related to CKD in a general Japanese population. The objective of this study was to examine CKD risk associated with WCHT and MHT as determined by ambulatory blood pressure (ABP) monitoring. Among 1023 residents in the general Japanese population of Ohasama, ABP and casual blood pressure (CBP) levels were recorded and blood and urine samples were collected. CKD was defined as a positive proteinuria and/or estimated glomerular filtration rate o60 ml min À1 per 1.73 m 2 . Participants were categorized into four groups using daytime ABP of 140/85 mm Hg and CBP of 140/90 mm Hg as cutoff points: SNBP, 60.0%; WCHT, 15.4%; MHT, 15.0%; and sustained hypertension (SHT), 9.6%. Odds ratios (ORs) for prevalence of CKD were calculated using a multiple logistic regression model. Compared with SNBP, risk of CKD was significantly higher in SHT (OR, 2.81; 95% confidence interval (CI), 1.66-4.75; P¼0.0001), MHT (OR, 2.29; 95% CI, 1.45-3.63; P¼0.0004) and WCHT (OR, 1.67; 95% CI, 1.03-2.71; P¼0.0368). CKD was significantly associated with MHT and WCHT on the basis of ABP monitoring compared with SNBP in the general Japanese population. Keywords: ambulatory blood pressure; chronic kidney disease; masked hypertension; white-coat hypertension INTRODUCTION Ambulatory blood pressure (ABP) has recently been the focus of large amounts of research, and the utility and usefulness of this technique have been recognized and established in the diagnosis and management of hypertension. 1-3 ABP is also considered as a useful tool for detecting overall blood pressure (BP) load, nighttime BP level and circadian and short-term variations in BP. These parameters contribute to the diagnosis and treatment of hypertension. [4][5][6] The measurement of ABP has enabled us to identify a subgroup of individuals with white-coat hypertension (WCHT), showing persistent hypertensive casual BP (CBP) but normal ABP, and a subgroup of individuals with masked hypertension (MHT), showing normal CBP but hypertensive ABP. MHT is reported to be associated strongly with high risk of

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Section: Usefulness Of Ambulatory Blood Pressure Monitoring In Ckdmentioning

confidence: 88%

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

et al. 2010

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“…A post hoc analysis from the Prevention of Renal and Vascular End-Stage Disease study 7 showed that a category of subjects with a decreased eGFR but normoalbuminuria was not at increased risk of CVD, and the impact of reduced GFR was shown by PROSPER (Prospective study of Pravastatin in the Elderly at Risk) to be greater for coronary artery disease (CAD) than for stroke in elderly people. 8 We have recently shown that albuminuria, but not reduced eGFR, is associated with not only incident symptomatic stroke 9 but also prevalent silent cerebral infarction 10 in patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

Association of albuminuria and reduced estimated glomerular filtration rate with incident stroke and coronary artery disease in patients with type 2 diabetes

et al. 2010

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It is unclear whether albuminuria and reduced glomerular filtration rate (GFR) independently increase the risk of incident stroke and coronary artery disease (CAD) in Japanese patients with diabetes. We investigated the independent effects of albuminuria and estimated GFR (eGFR) on the first occurrence of stroke and CAD in patients with type 2 diabetes mellitus (T2DM). We studied 1002 T2DM patients with eGFR (ml min À1 per 1.73 m 2 ) X15 and had no previous cardiovascular disease (CVD) history. GFR was estimated using the modified three-variable equation for the Japanese. Patients were divided into four eGFR categories: X90, 60-89, 30-59 and 15-29. The end point was an incident stroke and CAD events. The Cox proportional hazard model was used to calculate hazard ratio and 95% confidence interval. During a mean follow-up period of 5.2±2.1 years, 72 episodes of stroke and 90 of CAD were observed. Multivariate Cox analysis revealed no significant association between the eGFR category and incident stroke. The stroke hazard ratio (95% confidence interval) in reference to patients with an eGFR X90 was 0.78 (0.40-1.56) for patients with an eGFR of 60-89, 1.47 (0.70-3.10) for patients with an eGFR of 30-59 and 1.14 (0.39-3.35) for patients with an eGFR of 15-29. Reduced eGFR was a significant risk factor for CAD, with hazard ratios (95% confidence interval) for patients with an eGFRs of 60-89, 30-59 and 15-29 at 1.81 (1.01-3.57), 2.03 (1.04-4.40) and 3.01 (1.13-8.02), respectively. Reduced eGFR is independently associated with incident CAD but not stroke in Japanese patients with T2DM.

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“…For example, studies carried out in Holland 26 and in the United States 27 have reported a significant increase in the occurrence of cardiovascular events in patients with CKD stage 3B (or eGFR < 45 mL/min/1.73m 2 ) without proteinuria. On the other hand, in a study with patients after myocardial infarction 28 and in two other populationbased studies, 29,30 the risk of cardiovascular events adjusted for age and sex was not statistically elevated in patients with stage 3 CKD and without proteinuria, although it was clearly increased in those who had proteinuria.…”

Section: Prevention Of Medical Error (Drug Nephrotoxicity)mentioning

confidence: 84%

“…Nowadays, however, it is evident that macroalbuminuria also associates with cardiovascular outcomes, 32,33 and microalbuminuria identifies patients with CKD and predicts those who will progress to RRT in diabetes 34,35 or hipertensives, 36 or in the general population. 19,20,29 In conclusion, estimated GFR from plasma creatinine and measurement of microalbuminuria or macroalbuminuria (proteinuria) are simple, widely available, and high relevant clinical tests. They should be regularly performed in patients at the risk of CKD (diabetics, hypertensives, elderly, relatives on RRT), particularly in the pre-clinical stages of the disease (when eGFR is greater than 60 mL/min/1.73m 2 ), as well as in patients with CVD.…”

Section: Prevention Of Medical Error (Drug Nephrotoxicity)mentioning

confidence: 99%

Dia Mundial do Rim 2011 albuminúria e creatinina: testes simples, baratos e essenciais no curso da DRC

Bastos¹,

Andriolo²,

Kirsztajn³

2011

J. Bras. Nefrol.

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Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion

Cited by 153 publications

References 27 publications

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

Association of albuminuria and reduced estimated glomerular filtration rate with incident stroke and coronary artery disease in patients with type 2 diabetes

Dia Mundial do Rim 2011 albuminúria e creatinina: testes simples, baratos e essenciais no curso da DRC

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