Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Subclinical Renal Insufficiency Range of Estimated Glomerular Filtration Rate and Microalbuminuria Are Independently Associated with Increased Arterial Stiffness in Never Treated Hypertensives

  • Nah, Deuk-Young (Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine) ;
  • Lee, Chang Geun (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Bae, Jun-Ho (Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine) ;
  • Chung, Jin-Wook (Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine) ;
  • Rhee, Moo-Yong (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Kim, Ji-Hyun (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Kim, Yong-Seok (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Kim, Young-Kwon (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Lee, Myoung-Mook (Cardiovascular Center, Department of Internal Medicine, Dongguk University Ilsan Hospital)
  • Published : 2013.04.30
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Abstract

Background and Objectives: Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (${\geq}60mL/min/1.73m^2$) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin. Subjects and Methods: Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, $50.1{\pm}10.4$ years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR ${\geq}90mL/min/1.73m^2$ (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/$1.73m^2$ (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU. Results: Group 1 had the lowest hfPWV ($964.6{\pm}145.4$; group 2, $1013.5{\pm}168.9$; group 3, $1058.2{\pm}238.0$; group 4, $1065.8{\pm}162.9$ cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048). Conclusion: Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.

Keywords

References

  1. Viazzi F, Leoncini G, Conti N, et al. Combined effect of albuminuria and estimated glomerular filtration rate on cardiovascular events and allcause mortality in uncomplicated hypertensive patients. J Hypertens 2010;28:848-55. https://doi.org/10.1097/HJH.0b013e328336ed09
  2. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, 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;375:2073-81. https://doi.org/10.1016/S0140-6736(10)60674-5
  3. Leoncini G, Sacchi G, Ravera M, et al. Microalbuminuria is an integrated marker of subclinical organ damage in primary hypertension. J Hum Hypertens 2002;16:399-404. https://doi.org/10.1038/sj.jhh.1001408
  4. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236-41. https://doi.org/10.1161/01.HYP.37.5.1236
  5. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28:1462-536.
  6. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266.
  7. Rhee MY, Lee HY, Park JB. Measurements of Arterial Stiffness: Methodological Aspects. Korean Circ J 2008;38:343-50. https://doi.org/10.4070/kcj.2008.38.7.343
  8. Bian SY, Guo HY, Ye P, et al. Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function. J Geriatr Cardiol 2012;9:158-65. https://doi.org/10.3724/SP.J.1263.2012.03051
  9. Hermans MM, Henry R, Dekker JM, et al. Estimated glomerular filtration rate and urinary albumin excretion are independently associated with greater arterial stiffness: the Hoorn Study. J Am Soc Nephrol 2007;18:1942-52. https://doi.org/10.1681/ASN.2006111217
  10. Kawamoto R, Kohara K, Tabara Y, et al. An association between decreased estimated glomerular filtration rate and arterial stiffness. Intern Med 2008;47:593-8. https://doi.org/10.2169/internalmedicine.47.0825
  11. Astor BC, Hallan SI, Miller ER 3rd, Yeung E, Coresh J. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol 2008;167:1226-34. https://doi.org/10.1093/aje/kwn033
  12. Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106:1777-82. https://doi.org/10.1161/01.CIR.0000031732.78052.81
  13. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004;110:32-5. https://doi.org/10.1161/01.CIR.0000133312.96477.48
  14. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434-9. https://doi.org/10.1161/01.CIR.99.18.2434
  15. Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM. Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients. Hypertension 2005;45:592-6. https://doi.org/10.1161/01.HYP.0000159190.71253.c3
  16. Kielstein JT, Boger RH, Bode-Boger SM, et al. Marked increase of asymmetric dimethylarginine in patients with incipient primary chronic renal disease. J Am Soc Nephrol 2002;13:170-6.
  17. Chauveau P, Chadefaux B, Coude M, et al. Hyperhomocysteinemia, a risk factor for atherosclerosis in chronic uremic patients. Kidney Int Suppl 1993;41:S72-7.
  18. Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002;39:10-5. https://doi.org/10.1161/hy0102.099031
  19. Benetos A, Adamopoulos C, Bureau JM, et al. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation 2002;105:1202-7. https://doi.org/10.1161/hc1002.105135
  20. Emoto M, Nishizawa Y, Kawagishi T, et al. Stiffness indexes beta of the common carotid and femoral arteries are associated with insulin resistance in NIDDM. Diabetes Care 1998;21:1178-82. https://doi.org/10.2337/diacare.21.7.1178
  21. Lajemi M, Labat C, Gautier S, et al. Angiotensin II type 1 receptor-153A/G and 1166A/C gene polymorphisms and increase in aortic stiffness with age in hypertensive subjects. J Hypertens 2001;19:407-13. https://doi.org/10.1097/00004872-200103000-00008
  22. Koenig W. Update on integrated biomarkers for assessment of longterm risk of cardiovascular complications in initially healthy subjects and patients with manifest atherosclerosis. Ann Med 2009;41:332-43. https://doi.org/10.1080/07853890902769675
  23. Raymond NT, Zehnder D, Smith SC, Stinson JA, Lehnert H, Higgins RM. Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age. Nephrol Dial Transplant 2007;22:3214-20. https://doi.org/10.1093/ndt/gfm396
  24. Avolio AP, Deng FQ, Li WQ, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 1985;71:202-10. https://doi.org/10.1161/01.CIR.71.2.202
  25. van der Velde M, Bakker SJ, de Jong PE, Gansevoort RT. Influence of age and measure of eGFR on the association between renal function and cardiovascular events. Clin J Am Soc Nephrol 2010;5:2053-9. https://doi.org/10.2215/CJN.08851209
  26. Tomiyama H, Arai T, Koji Y, et al. The age-related increase in arterial stiffness is augmented in phases according to the severity of hypertension. Hypertens Res 2004;27:465-70. https://doi.org/10.1291/hypres.27.465

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