Relationship between Urinary Albumin Excretion and Left Ventricular Mass with Mortality in Patients with Type 2 Diabetes

Nobakhthaghighi, Niloofar; Kamgar, Mohammed; Bekheirnia, Mir Reza; McFann, Kim; Estacio, Raymond O.; Schrier, Robert W.

doi:10.2215/cjn.00750306

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…38 Moreover, there was a highly significant relationship between increased LVM and the three stages of albuminuria, (P <0.0001 for all) independent of blood pressure (Figure 9). These results indicate that the relationship between urinary albumin excretion and cardiovascular mortality might be related to increased LVM.…”

Section: Other Results Of the Abcd Trial Effect Of Increased Lvm On Cmentioning

confidence: 81%

Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial

Schrier

Estacio²,

Mehler³

et al. 2007

Nat Rev Nephrol

113

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The hypertensive and normotensive Appropriate Blood Pressure Control in Diabetes (ABCD) studies were prospective, randomized, interventional clinical trials with 5 years of follow-up that examined the role of intensive versus standard blood pressure control in a total of 950 patients with type 2 diabetes mellitus. In the hypertensive ABCD study, a significant decrease in mortality was detected in the intensive blood pressure control group when compared with the standard blood pressure control group. There was also a marked reduction in the incidence of myocardial infarction when patients were randomly assigned to initial antihypertensive therapy with angiotensin-converting-enzyme inhibition rather than calcium channel blockade. The results of the normotensive ABCD study included associations between intensive blood pressure control and significant slowing of the progression of nephropathy (as assessed by urinary albumin excretion) and retinopathy, and fewer strokes. In both the hypertensive and normotensive studies, mean renal function (as assessed by 24 h creatinine clearance) remained stable during 5 years of either intensive or standard blood pressure intervention in patients with normoalbuminuria (<30 mg/24 h) or microalbuminuria (30-300 mg/24 h) at baseline. By contrast, the rate of creatinine clearance in patients with overt diabetic nephropathy (>300 mg/24 h; albuminuria) at baseline decreased by an average of 5 ml/min/year in spite of either intensive or standard blood pressure control. Analysis of the results of 5 years of follow-up revealed a highly significant correlation of all-cause and cardiovascular mortality with left ventricular mass and severity of albuminuria.

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Section: Other Results Of the Abcd Trial Effect Of Increased Lvm On Cmentioning

confidence: 81%

Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial

Schrier

Estacio²,

Mehler³

et al. 2007

Nat Rev Nephrol

113

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“…In addition, albuminuria has been associated with the presence of left ventricular hypertrophy in patients with hypertension and diabetes. [25][26][27] It has also been demonstrated that in individuals with stable underlying coronary artery disease, proteinuria confers increased risks of all-cause and cardiovascular mortality, even at lower levels within the defined "normal range". [28][29][30][31] This has also been shown in individuals who have recently suffered a coronary event.…”

mentioning

confidence: 99%

Proteinuria, a marker of cardiovascular risks

Maheshwari¹

2018

JDMDC

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“…Another important finding of this study is that a high UPCR were associated with a high CTR in the patients with CKD stages 3-5. Previous studies have assessed LVM using electrocardiography, echocardiography, and magnetic resonance imaging (28)(29)(30). The MONICA/KORA study demonstrated that even low levels of albuminuria was a significant predictor of LVM assessed using echocardiography in the general population (28).…”

Section: Discussionmentioning

confidence: 99%

Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

Huang

et al. 2020

Int. J. Med. Sci.

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Background: Patients with chronic kidney disease (CKD) are associated with high prevalence rates of proteinuria, vascular calcification and cardiomegaly. In this study, we investigated relationships among proteinuria, aortic arch calcification (AoAC) and cardio-thoracic ratio (CTR) in patients with CKD stage 3A-5. In addition, we investigated correlations among proteinuria and decline in renal function, overall and cardiovascular (CV) mortality. Methods: We enrolled 482 pre-dialysis patients with CKD stage 3A-5, and determined AoAC and CTR using chest radiography at enrollment. The patients were stratified into four groups according to quartiles of urine protein-to-creatinine ratio (UPCR). Results: The patients in quartile 4 had a lower estimated glomerular filtration rate (eGFR) slope, and higher prevalence rates of rapid renal progression, progression to commencement of dialysis, overall and CV mortality. Multivariable analysis showed that a high UPCR was associated with high AoAC (unstandardized coefficient β: 0.315; p = 0.002), high CTR (unstandardized coefficient β: 1.186; p = 0.028) and larger negative eGFR slope (unstandardized coefficient β:-2.398; p < 0.001). With regards to clinical outcomes, a high UPCR was significantly correlated with progression to dialysis (log per 1 mg/g; hazard ratio [HR], 2.538; p = 0.003), increased overall mortality (log per 1 mg/g; HR, 2.292; p = 0.003) and increased CV mortality (log per 1 mg/g; HR, 3.195; p = 0.006). Conclusions: Assessing proteinuria may allow for the early identification of high-risk patients and initiate interventions to prevent vascular calcification, cardiomegaly, and poor clinical outcomes.

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Relationship between Urinary Albumin Excretion and Left Ventricular Mass with Mortality in Patients with Type 2 Diabetes

Cited by 12 publications

References 29 publications

Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial

Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial

Proteinuria, a marker of cardiovascular risks

Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

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