Proteinuria and Stroke: A Meta-analysis of Cohort Studies

Ninomiya, Toshiharu; Perkovic, Vlado; Verdon, Christine; Barzi, Federica; Cass, Alan; Gallagher, Martin; Jardine, Meg; Anderson, Craig S.; Chalmers, John; Craig, Jonathan C.; Huxley, Rachel R.

doi:10.1053/j.ajkd.2008.08.032

Cited by 132 publications

(104 citation statements)

References 31 publications

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“…4 Indeed, it is thought that assessing kidney structure using this relatively simple test could be a window to the systemic vasculature, that is, leaky renal vessels reflecting the permeability of the vasculature in general and an individual's susceptibility to target organ damage. 5 There is convincing evidence of an independent positive relationship between overt proteinuria and stroke risk, 6 but the nature and magnitude of the link between microalbuminuria and incident stroke has so far not been systematically investigated. In this study, we aimed to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective cohort studies using meta-analysis.…”

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confidence: 99%

Impact of Microalbuminuria on Incident Stroke

Lee

Saver²,

Chang³

et al. 2010

Stroke

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Background and Purpose-Microalbuminuria, a marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and magnitude of the link between microalbuminuria and incident stroke has not been clearly defined. The purpose of this study was to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective studies using meta-analysis. Methods-We conducted a systematic search of electronic databases and bibliographies for studies reporting a multivariate-adjusted estimate, represented as relative risk with 95% CI, of the association between microalbuminuria and stroke risk. Studies were excluded if a majority of study participants had established kidney disease or pre-eclampsia. Estimates were combined using a random-effect model. Results-We identified 12 studies, with a total of 48 596 participants and 1263 stroke events. Overall, presence of microalbuminuria was associated with greater stroke risk (relative risk, 1.92; 95% CI, 1.61 to 2.28; PϽ0.001) after adjustment for established cardiovascular risk factors. There was evidence of significant heterogeneity in the magnitude of the association across studies (P for heterogeneity Ͻ0.001, I

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mentioning

confidence: 99%

Impact of Microalbuminuria on Incident Stroke

Lee

Saver²,

Chang³

et al. 2010

Stroke

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“…Менее определена взаимосвязь заболеваний почек и развития ишемического инсульта (ТИА). В ряде исследований показано, что почечная дис-функция является фактором риска нарушения моз-гового кровообращения независимо от локализа-ции мозгового сосудистого события или наличия других факторов риска, таких как артериальная гипертензия, диабет и альбуминурия [4,5]. По дан-ным Bos M. J. et al, снижение скорости клубочко-вой фильтрации (СКФ) ниже 60 мл/мин -сильный фактор риска для геморрагического, но не шемиче-ского инсульта [6].…”

Section: оригинальные статьиunclassified

Chronic Kidney Disease and Cerebrocardiovascular Complications in Arterial Hypertension: Results of Perindopril А Usage With Indapamid

Шеметова¹,

Орлова²,

Небесных³

et al. 2014

Russ J Cardiol

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Цель. Оценка развития кардио-и цереброваскулярных осложнений у больных артериальной гипертонией в зависимости от наличия или отсутствия пораже-ния почек, оценка органопротективного действия периндоприла в сочетании с индапамидом (препараты Нолипрел А и Нолипрел А форте). Материал и методы. Осуществлено трехлетнее проспективное наблюдение 52 амбулаторных больных с АГ. Диагноз ХБП устанавливался в соответствии с рекомендациями KDOQI, 2002. Все пациенты получали антигипертензивную терапию с включением Нолипрела в дозе 2,5 + 0,625 мг (Нолипрел А) -(10) или в дозе 5 + 1,25 мг (Нолипрел А форте) -(42). Группа сравнения -25 паци-ентов, получающих антигипертензивную терапию без Нолипрела. Первичной конечной точкой считали развитие ХБП или достижение следую-щей, более тяжелой стадии ХБП. Вторичные точки: кардио-или цереброваску-лярное событие (инфаркт миокарда, ишемический инсульт, транзиторная ишемическая атака). Результаты. В группе пациентов, принимавших комбинацию периндоприла А с индапамидом, первичная конечная точка достигнута у 12 (23%) больных, в группе без данной комбинации достижение конечной точки зарегистриро-вано у 12 (48%) пациентов, р=0,05. Регресс тяжести ХБП зарегистрирован у 5 (15,15%) пациентов в основной группе, и ни у одного больного с исходной ХБП в группе сравнения. В основной группе с ХБП кардиоцеребральные события произошли у 11 (33,3%) пациентов, в группе без почечного поражения 1 (5,25%) пациент имел кардиоцеребральное событие, р<0,05. Между основными группами и группой сравнения также обнаруживаются существенные различия в частоте инфаркта миокарда и ишемического инсульта: 12 (23%) против 14 (56%), р=0,009. В группе пациентов, не получавших комбинацию периндоприла А с индапамидом, кардиоваскулярные события происходят почти в 10 раз чаще, чем в основной группе без ХБП, и почти в 2 раза чаще, чем в группе больных с ХБП, принимающих данную комбинацию. Заключение. Проспективное наблюдение обнаружило более высокую частоту развития ишемического инсульта или транзиторной ишемической атаки, а также кардиоваскулярного события в группе пациентов с хронической болезнью почек по сравнению с группой пациентов без почечного поражения. Динамическое наблюдение за больными с АГ, использование комбинации периндоприла с индапамидом (Нолипрел А, Нолипрел А форте) позволяет достичь антигипертензивной и органопротективной цели. Российский кардиологический журнал 2014, 8 (112): 38-42Ключевые слова: артериальная гипертония, хроническая болезнь почек, кардиоцеребральное событие, Нолипрел А, Нолипрел А форте. Results. In the group of therapy with combination of perindopril A with indapamide primary endpoint was reached by 12 (23%) patients, in the group without this combination in 12 (48%) patients, p=0,05. Regression of severity of CKD was marked in 5 (15,5%) patients in the main group and in no one in comparison group.In the main group with CKD the cardiocerebral events occured in 11 (33,3%) patients, in the group without kidney injury in 1 (5,25%) patient had cardiocerebral event, p<0,05. Between the main and the co...

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“…6,15,17 The latter study also demonstrated that residual proteinuria reliably predicted long-term kidney prognosis regardless of blood pressure control and treatment randomization and independent of initial values of proteinuria and its reduction during follow-up. 39 Proteinuria also is a strong predictor of cardiovascular risk 40,41 independent of level of kidney function. 3, 42 In a meta-analysis of 10 cohorts involving 266,975 people at increased risk of CKD, lower GFR and higher albuminuria predicted cardiovascular disease and all-cause mortality independently of each other.…”

Section: Proteinuria: the Second "P" For Ckd Progressionmentioning

confidence: 99%

Blood Pressure, Proteinuria, and Phosphate as Risk Factors for Progressive Kidney Disease: A Hypothesis

Cozzolino

Gentile

Mazzaferro

et al. 2013

American Journal of Kidney Diseases

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Chronic kidney disease (CKD) affects approximately 500 million people worldwide and is increasingly common in both industrialized and emerging countries. Although the mechanisms underlying the inexorable progression of CKD are incompletely defined, recent discoveries may pave the way to a more comprehensive understanding of the pathophysiology of CKD progression and the development of new therapeutic strategies. In particular, there is accumulating evidence indicating a key role for the complex and yet incompletely understood system of divalent cation regulation, which includes phosphate metabolism and the recently discovered fibroblast growth factor 23 (FGF-23)/klotho system, which seems inextricably associated with vitamin D deficiency. The aim of this review is to discuss the links between high blood pressure, proteinuria, phosphate levels, and CKD progression and explore new therapeutic strategies to win the fight against CKD. Am J Kidney Dis. xx(x):xxx. © 2013 by the National Kidney Foundation, Inc. INDEX WORDS:Chronic kidney disease; vitamin D deficiency; blood pressure; proteinuria; phosphate.C hronic kidney disease (CKD) is a silent killer.Four of 5 people with advanced CKD are not aware of the disease until death is imminent and kidney replacement therapy (dialysis or kidney transplantation) is unavoidable. Unfortunately, Ͻ10% of people requiring replacement therapy have access to it, and more than 1 million people worldwide die of untreated kidney failure each year because dialysis or kidney transplantation is unaffordable in most countries. This represents a huge economic burden, with global costs from 2000-2010 surpassing $1 trillion. 1,2 Worsening kidney function is associated with a marked increase in cardiovascular morbidity and mortality 1,3 independent of other risk factors. Coexistent hypertension is present in ϳ80% of patients with CKD and worsens cardiovascular outcomes because only 64% of patients with CKD achieve adequate blood pressure control. 4 As a consequence, only a minority of the hundreds of thousands of patients with stages 3 and 4 CKD reach kidney failure. 5 Proteinuria also is an important prognostic factor in patients with CKD. Although patients with nonproteinuric CKD are at greater risk of cardiovascular mortality than progression to kidney failure, the opposite may be true for the presence of proteinuria. Patients from the REIN (Ramipril Efficacy in Nephropathy) Study who were in the highest tertile of baseline proteinuria (protein excretion Ն3.8 g/d) also experienced the highest rate of glomerular filtration rate (GFR) loss during followup. 6 In addition, although post hoc analysis of RENAAL (Reduction of Endpoints in NIDDM [Non-InsulinDependent Diabetes Mellitus] With the Angiotensin II Antagonist Losartan) showed that 85% of patients with proteinuria with protein excretion Ն3 g/d reached the composite end point of doubling of serum creatinine level or end-stage renal disease (ESRD), only 44% of these patients reached the composite cardiovascular outcome. 7 Besides the we...

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Proteinuria and Stroke: A Meta-analysis of Cohort Studies

Cited by 132 publications

References 31 publications

Impact of Microalbuminuria on Incident Stroke

Impact of Microalbuminuria on Incident Stroke

Chronic Kidney Disease and Cerebrocardiovascular Complications in Arterial Hypertension: Results of Perindopril А Usage With Indapamid

Blood Pressure, Proteinuria, and Phosphate as Risk Factors for Progressive Kidney Disease: A Hypothesis

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