| Peer-Reviewed

The Impacts of Albuminuria and eGFR on Cardiovascular Disease

Received: 14 May 2017    Accepted: 25 May 2017    Published: 11 July 2017
Views:       Downloads:
Abstract

Albuminuria is often used as a surrogate marker for the risk of fatal and non-fatal events in clinical trials of antihyperglycemic medications or in antihypertensive therapy. Similarly, low estimated glomerular filtration rate (eGFR), which is a common manifestation of progressed diabetic nephropathy, has also been demonstrated to be an independent risk factor for cardiovascular events and death. Recent evidence suggests that both high albuminuria and low eGFR are independent risk factors for progressive kidney failure and cardiovascular disease. The purpose of this study was to investigate the impacts of albuminuria and low eGFR on the risk of cardiovascular disease. A cross-sectional design was used. Data were collected through adults’ health examinations by a hospital in a certain area in Pingtung County between 2011 and 2015. The health data base included participants’ basic information, physical examination and blood examination results. Use abbreviated modification of diet in renal disease, aMDRD (Abbreviated modification of diet in renal disease) formula to estimate eGFR. Use metabolic syndrome to define the criteria of rising blood pressure, blood sugar, blood lipids as an important cardiovascular disease (CVD) indicator and then calculation of the 10-year risk for CVD was completed using data from the Framingham Heart Study and a computer was used to determine risk values. In this study, ≤ 10% was defined as low risk, 11-20% was defined as moderate risk, and > 20% was defined as high risk. As albuminuria and eGFR approached critically high values, initially moderate and high 10-year risk levels for CVD tended to increase. Logistic regression analysis showed that patients with severe albuminuria and severe eGFR had higher risks of metabolic syndrome, abnormal waist circumference, hyperglycemia, reduced high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and elevated blood pressure. The study concluded that albuminuria and eGFR are risk factors for CVD and can increase a patient’s 10-year risk of CVD.

Published in American Journal of Health Research (Volume 5, Issue 4)
DOI 10.11648/j.ajhr.20170504.12
Page(s) 99-105
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Albuminuria, Glomerular Filtration Rate, Cardiovascular Disease, Metabolic Syndrome

References
[1] Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007; 72: 247–59. [PubMed: 17568785].
[2] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39: S1–266. [PubMed: 11904577].
[3] Wen CP, Cheng TY, Tsai MK, et al. All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet. 2008; 371: 2173–82. [PubMed: 18586172].
[4] Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol. 2003; 14: S131–8. [PubMed: 12819318].
[5] Hallan SI, Coresh J, Astor BC, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol. 2006; 17: 2275–84. [PubMed: 16790511].
[6] Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007; 298: 2038–47. [PubMed: 17986697].
[7] Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003; 108: 2154–69. [PubMed: 14581387].
[8] Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010; 375(9731): 2073–2081. [PubMed: 20483451].
[9] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013; (Suppl. 3)(1): 1–150.
[10] Crowe E, Halpin D, Stevens P, on behalf of the Guideline Development G. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ. 2008; 337(sep29_1): a1530. [PubMed: 18824486].
[11] van der Velde M, Matsushita K, Coresh J, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative metaanalysis of high-risk population cohorts. Kidney Int. 2011; 79(12): 1341–1352. [PubMed: 21307840].
[12] Gansevoort RT, Matsushita K, van der Velde M, et al. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int. 2011; 80(1): 93–104. [PubMed: 21289597].
[13] Astor BC, Matsushita K, Gansevoort RT, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011; 79(12): 1331–1340. [PubMed: 21289598].
[14] The College of American Pathologists. [Accessed March, 6, 2012] Current Status Of Reporting Estimated Glomerular Filtration Rate (eGFR) for Adults. http://www.cap.org/apps/docs/committees/ chemistry/current_status_of_reporting_eGF R_2011.pdf.
[15] Hui X, Matsushita K, Sang Y, et al. CKD and cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study: interactions with age, sex, and race. Am J Kidney Dis. 2013 Oct; 62(4): 691-702. doi: 10.1053/j.ajkd.2013.04.010. Epub 2013 Jun 13.
[16] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May, 285(19): 2486-2497.
[17] Lee PH, Chang HY, Tung CW, et al. Microalbuminuria, a Sign Usually Ignored; Journal of Internal Medicine of Taiwan. 2009; 20(4), 275 – 284. DOI: 10.6314/JIMT.2009.20(4).01.
[18] Garg JP, Bakris GL. Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vasc Med 2002; 7: 35-43.
[19] Hillege H, Van Gilst W, de Zeeuw D, et al. Renal function as a predictor of prognosis in chronic heart failure. Heart Fail Monit. 2002; 2(3): 78-84.
[20] Kuma A, Uchino B, Ochiai Y, et al. Impact of low-density lipoprotein cholesterol on decline in estimated glomerular filtration rate in apparently healthy young to middle-aged working men. Clin Exp Nephrol. 2017 Apr 6. doi: 10.1007/s10157-017-1407-8. PMID: 28386655.
[21] Tsuruya K, Yoshida H, Nagata M, et al. Impact of the Triglycerides to High-Density Lipoprotein Cholesterol Ratio on the Incidence and Progression of CKD: A Longitudinal Study in a Large Japanese Population. Am J Kidney Dis. 2015 Dec; 66(6): 972-83. doi: 10.1053/j.ajkd.2015.05.011. PMID: 26145254.
[22] Hayashi K, Takayama M, Abe T, et al. Investigation of Metabolic Factors Associated with eGFR Decline Over 1 Year in a Japanese Population without CKD. J Atheroscler Thromb. 2017 Jan 26. doi: 10.5551/jat.38612. PMID: 28123142.
[23] Huh JH, Yadav D, Kim JS, et al. An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study. Metabolism. 2017 Feb; 67: 54-61. doi: 10.1016/j.metabol.2016.11.003. PMID: 28081778.
[24] Cheng HT, Huang JW, Chiang CK, et al. Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly. J Clin Endocrinol Metab. 2012 Apr; 97(4): 1268-76. doi: 10.1210/jc.2011-2658. PMID: 22337909.
[25] Yeh SJ, Jeng JS, Tang SC, et al. Low estimated glomerular filtration rate is associated with poor outcomes in patients who suffered a large artery atherosclerosis stroke. Atherosclerosis. 2015 Apr; 239(2): 328-34. doi: 10.1016/j.atherosclerosis.2015.01.038. PMID: 25682031.
[26] Wang X, Wang Y, Wang C, et al. Association between estimated glomerular filtration rate and clinical outcomes in patients with acute ischaemic stroke: results from China National Stroke Registry. Age Ageing. 2014 Nov; 43(6): 839-45. doi: 10.1093/ageing/afu090. PMID: 25141853.
[27] Ohsawa M, Fujioka T, Ogasawara K, et al. High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria: A prospective cohort study. Int J Cardiol. 2013 Dec 10; 170(2): 167-72. doi: 10.1016/j.ijcard.2013.10.076. Epub 2013 Oct 29.
[28] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351(13): 1296–305.
[29] Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351(13): 1285–95.
[30] Weiner DE, Tighiouart H, Amin MG, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community based studies. J Am Soc Nephrol 2004; 15(5): 1307–15.
[31] Tonelli M, Klarenbach SW, Lloyd AM, et al. Higher estimated glomerular filtration rates may be associated with increased risk of adverse outcomes, especially with concomitant proteinuria. Kidney Int 2011; 80(12): 1306–14.
[32] Ohsawa M, Tanno K, Itai K, et al. Comparison of predictability of future cardiovascular events between chronic kidney disease (CKD) stage based on CKD Epidemiology Collaboration equation and that based onmodification of diet in renal disease equation in the Japanese general Population. Circ J 2013; 77(5): 1315–25.
[33] Matsushita K, Selvin E, Bash LD, et al. Risk implications of the new CKD Epidemiology Collaboration (CKD-EPI) equation compared with the MDRD study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) study. Am J Kidney Dis 2010; 55(4): 648–59.
[34] Nagata M, Ninomiya T, Kiyohara Y, et al. Prediction of cardiovascular disease mortality by proteinuria and reduced kidney function: pooled analysis of 39,000 individuals from 7 cohort studies in Japan. Am J Epidemiol 2013; 178(1): 1-11.
[35] Tonelli M, Muntner P, Lloyd A, et al. Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease: a cohort study. Ann Intern Med 2011; 154(1): 12–21.
[36] Al Suwaidi J, Reddan DN, Williams K, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002, 106(8): 974–980.
[37] Damman K, Navis G, Voors AA, et al. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 2007, 13(8): 599–608.
[38] Hillege HL, Nitsch D, Pfeffer MA, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 2006, 113(5): 671–678.
[39] Kim CS, Choi JS, Park JW, et al. Concomitant renal insufficiency and diabetes mellitus asprognostic factors for acute myocardial infarction. Cardiovasc Diabetol 2011, 10: 95.
[40] Schrier RW. Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor? J Am Coll Cardiol 2006, 47(1): 1–8.
[41] Vanholder R, Massy Z, Argiles A, et al. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant 2005, 20(6): 1048–1056.
Cite This Article
  • APA Style

    Hao-Huan Hu, Chin-Wen Hsieh, Yu-Kuei Liao, Szu-Mei Hsiao, Pi-Li Lin, et al. (2017). The Impacts of Albuminuria and eGFR on Cardiovascular Disease. American Journal of Health Research, 5(4), 99-105. https://doi.org/10.11648/j.ajhr.20170504.12

    Copy | Download

    ACS Style

    Hao-Huan Hu; Chin-Wen Hsieh; Yu-Kuei Liao; Szu-Mei Hsiao; Pi-Li Lin, et al. The Impacts of Albuminuria and eGFR on Cardiovascular Disease. Am. J. Health Res. 2017, 5(4), 99-105. doi: 10.11648/j.ajhr.20170504.12

    Copy | Download

    AMA Style

    Hao-Huan Hu, Chin-Wen Hsieh, Yu-Kuei Liao, Szu-Mei Hsiao, Pi-Li Lin, et al. The Impacts of Albuminuria and eGFR on Cardiovascular Disease. Am J Health Res. 2017;5(4):99-105. doi: 10.11648/j.ajhr.20170504.12

    Copy | Download

  • @article{10.11648/j.ajhr.20170504.12,
      author = {Hao-Huan Hu and Chin-Wen Hsieh and Yu-Kuei Liao and Szu-Mei Hsiao and Pi-Li Lin and Aih-Fung Chiu and Tsan Yang},
      title = {The Impacts of Albuminuria and eGFR on Cardiovascular Disease},
      journal = {American Journal of Health Research},
      volume = {5},
      number = {4},
      pages = {99-105},
      doi = {10.11648/j.ajhr.20170504.12},
      url = {https://doi.org/10.11648/j.ajhr.20170504.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20170504.12},
      abstract = {Albuminuria is often used as a surrogate marker for the risk of fatal and non-fatal events in clinical trials of antihyperglycemic medications or in antihypertensive therapy. Similarly, low estimated glomerular filtration rate (eGFR), which is a common manifestation of progressed diabetic nephropathy, has also been demonstrated to be an independent risk factor for cardiovascular events and death. Recent evidence suggests that both high albuminuria and low eGFR are independent risk factors for progressive kidney failure and cardiovascular disease. The purpose of this study was to investigate the impacts of albuminuria and low eGFR on the risk of cardiovascular disease. A cross-sectional design was used. Data were collected through adults’ health examinations by a hospital in a certain area in Pingtung County between 2011 and 2015. The health data base included participants’ basic information, physical examination and blood examination results. Use abbreviated modification of diet in renal disease, aMDRD (Abbreviated modification of diet in renal disease) formula to estimate eGFR. Use metabolic syndrome to define the criteria of rising blood pressure, blood sugar, blood lipids as an important cardiovascular disease (CVD) indicator and then calculation of the 10-year risk for CVD was completed using data from the Framingham Heart Study and a computer was used to determine risk values. In this study, ≤ 10% was defined as low risk, 11-20% was defined as moderate risk, and > 20% was defined as high risk. As albuminuria and eGFR approached critically high values, initially moderate and high 10-year risk levels for CVD tended to increase. Logistic regression analysis showed that patients with severe albuminuria and severe eGFR had higher risks of metabolic syndrome, abnormal waist circumference, hyperglycemia, reduced high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and elevated blood pressure. The study concluded that albuminuria and eGFR are risk factors for CVD and can increase a patient’s 10-year risk of CVD.},
     year = {2017}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - The Impacts of Albuminuria and eGFR on Cardiovascular Disease
    AU  - Hao-Huan Hu
    AU  - Chin-Wen Hsieh
    AU  - Yu-Kuei Liao
    AU  - Szu-Mei Hsiao
    AU  - Pi-Li Lin
    AU  - Aih-Fung Chiu
    AU  - Tsan Yang
    Y1  - 2017/07/11
    PY  - 2017
    N1  - https://doi.org/10.11648/j.ajhr.20170504.12
    DO  - 10.11648/j.ajhr.20170504.12
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 99
    EP  - 105
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20170504.12
    AB  - Albuminuria is often used as a surrogate marker for the risk of fatal and non-fatal events in clinical trials of antihyperglycemic medications or in antihypertensive therapy. Similarly, low estimated glomerular filtration rate (eGFR), which is a common manifestation of progressed diabetic nephropathy, has also been demonstrated to be an independent risk factor for cardiovascular events and death. Recent evidence suggests that both high albuminuria and low eGFR are independent risk factors for progressive kidney failure and cardiovascular disease. The purpose of this study was to investigate the impacts of albuminuria and low eGFR on the risk of cardiovascular disease. A cross-sectional design was used. Data were collected through adults’ health examinations by a hospital in a certain area in Pingtung County between 2011 and 2015. The health data base included participants’ basic information, physical examination and blood examination results. Use abbreviated modification of diet in renal disease, aMDRD (Abbreviated modification of diet in renal disease) formula to estimate eGFR. Use metabolic syndrome to define the criteria of rising blood pressure, blood sugar, blood lipids as an important cardiovascular disease (CVD) indicator and then calculation of the 10-year risk for CVD was completed using data from the Framingham Heart Study and a computer was used to determine risk values. In this study, ≤ 10% was defined as low risk, 11-20% was defined as moderate risk, and > 20% was defined as high risk. As albuminuria and eGFR approached critically high values, initially moderate and high 10-year risk levels for CVD tended to increase. Logistic regression analysis showed that patients with severe albuminuria and severe eGFR had higher risks of metabolic syndrome, abnormal waist circumference, hyperglycemia, reduced high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and elevated blood pressure. The study concluded that albuminuria and eGFR are risk factors for CVD and can increase a patient’s 10-year risk of CVD.
    VL  - 5
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • Division of Nephrology, Pingtung Christian Hospital, Pingtung, Taiwan

  • Division of Nephrology, Pingtung Christian Hospital, Pingtung, Taiwan

  • Department of Nursing, Pingtung Christian Hospital, Pingtung, Taiwan

  • Department of Nursing, Meiho University, Pingtung, Taiwan

  • Department of Nursing, Meiho University, Pingtung, Taiwan

  • Department of Nursing, Meiho University, Pingtung, Taiwan

  • Department of Health Business Administration, Meiho University, Pingtung, Taiwan

  • Sections