Interaction Between Renal Function and Microalbuminuria for Cardiovascular Risk in Hypertension

Abstract

Abstract-We investigated whether renal function and microalbuminuria are independent predictors and whether any interaction exists between them, regarding future cardiovascular disease in hypertensive patients (nϭ10 881) followed for 4.5 years. The primary end points (PEs) were fatal and nonfatal myocardial infarction and stroke and other cardiovascular deaths. Creatinine and glomerular filtration rate (GFR), estimated using the formulas of the Modification of Diet in Renal Disease study group and Cockroft and Gault and in a subsample (nϭ4929) of microalbuminuria and interaction terms of microalbuminuria and renal function, were related to the risk of the PE using Cox proportional hazards model after full adjustment. Increased creatinine (PϽ0.001), decreased GFR from Cockroft and Gault (Pϭ0.001), and decreased GFR from the Modification of Diet in Renal Disease study group (Pϭ0.001) were all independent risk factors for the PE. Stepwise exclusion of patients with the poorest renal function excluded the possibility that the relationship between decreasing renal function and the PE was driven only by patients with severely impaired renal function. Microalbuminuria and all 3 of the indices of renal function predicted the PE independent of each other. There was a significant interaction between microalbuminuria and GFR from Cockroft and Gault (Pϭ0.040) in prediction of the PE. Both renal function and microalbuminuria add independent prognostic information regarding cardiovascular risk in hypertensive patients. The cardiovascular risk associated with microalbuminuria increases with a decline in GFR, as demonstrated by a significant interaction between microalbuminuria and GFR from Cockroft and Gault. Because estimation of the total cardiovascular risk is essential for the aggressiveness of risk factor interventions, simultaneous inclusion of GFR and microalbuminuria in global cardiovascular risk assessment is essential.

Common variants in CNDP1 and CNDP2, and risk of nephropathy in type 2 diabetes

“…The formula for GFR (Cockroft and Gault) was: (ml min (plasma creatinine in μmol/l×F×BSA), where F is 0.8 in men and 0.85 in women [24]. All patients gave their written informed consent and the local ethics committees approved the study.…”

Effects of weight loss on renal function in overweight Japanese men

“…Many epidemiological and clinical studies have shown the presence of microalbuminuria 32,33 or proteinuria 15 as a marker of cardiovascular risks, however, Farbom et al 34 reported that microalbuminuria and renal function (creatinine, blood urea nitrogen and creatinine clearance (CCr)) are independently associated with future cardiovascular events. The decrease in CCr (glomerular filtration rate, GFR) was a precursor for the future cardiovascular events.…”

“…The decrease in CCr (glomerular filtration rate, GFR) was a precursor for the future cardiovascular events. 34 However, only few investigators have simultaneously taken into account the sympathetic nervous activity and renal function in the same study population, followed longitudinally to evaluate the relationships of sympathetic nervous activity with renal function during WL with life-style modifications. 30,35 In the present study, using plasma NE levels as a marker of sympathetic activity we evaluated the role of the sympathetic nervous system on renal function (measured serum creatinine and CCr) during WL over a 12-month period with mild caloric restriction and exercise (life-style modification).…”

Evaluation of Homocysteine, hsCRP and Microalbuminuria in Hypertensives without and with end Organ Damage-A Case Control Study

“…In hypertension, microalbuminuria was shown to associated with altered metabolism [12,13,14] Essential hypertension causes renal ischemia and nephrosclerosis, leading to renal impairment [15] .…”