Microalbuminuria. From diabetes to cardiovascular risk


Authors: V. Monhart 1,2
Authors‘ workplace: Interní klinika 1. lékařké fakulty UK a ÚVN Praha, přdnosta prof. MUDr. Miroslav Zavoral, Ph. D. 1;  Nefrologická ambulance Synlab Czech s. r. o. Praha 2
Published in: Vnitř Lék 2011; 57(3): 293-298
Category: 60th birthday of prof. Mudr. Jiřího Vítovce, CSc, FESC

Overview

An increased albuminuria level, known as microalbuminuria is associated with a range of diseases, most frequently with diabetes mellitus and hypertension. Microalbuminuria in type 1 diabetes is an early sign of diabetic nephropathy onset, while it tends to be an indicator of the level of cardiovascular risk in type 2 diabetes and essential hypertension. At present, an increased albumin excretion is considered to be a renal symptom of generalized endothelial dysfunction. A simple investigation, not bothersome to a patient, should be performed early and repeatedly in all patients with diabetes and hypertension, as low microalbuminaemia levels can be managed with appropriate treatment.

Key words:
microalbuminuria – diabetes mellitus – hypertension – endothelial dysfunction – cardiovascular risk


Sources

1. Ruggenenti P, Remuzzi G. Time to abandon microalbuminuria? Kidney Int 2006; 70: 1214–1222.

2. Lambers Heerspink HJ, Brantsma AH, de Zeeuw D et al. PREVEND Study Group. Albuminuria assessed from first-morning--void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemiol 2008; 168: 897–905.

3. Busby DE, Bakris GL. Comparison of commonly used assays for the detection of microalbuminuria. J Clin Hypertens 2004; 6 (Suppl 3): 8–12.

4. Levey AS, Eckardt KU, Tsukamoto et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improve Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089–2100.

5. de Zeeuw D, Parving HH, Hening RH et al. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol 2006; 17: 2100–2105.

6. Comper WD, Osicka TM, Clark M et al. Earlier detection of microalbuminuria in diabetic patients using a new urinary albumin assay. Kidney Int 2004; 65: 1850–1855.

7. Ewald B, Attia J. Which test to detect microalbuminuria in diabetic patients? A systematic review. Aust Fam Physician 2004; 33: 565–568.

8. de Jong PE, Curhan GC. Screening, monitoring, and treatment of albuminuria: Public health perspectives. J Am Soc Nephrol 2006; 17: 2120–2126.

9. The American Diabetes Association. Standards of medical care in diabetes – 2009. Diabetes Care 2009; 32 (Suppl 1): S13–S61.

10. Hillege HL, Janssen WM, Bak AA et al. Prevend Study Group. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001; 249: 519–526.

11. Romundstad S, Holmen J, Kvenild K et al. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: A 4.4-year follow-up study The Nord-Trøndelag Health Study (HUNT), Norway. Am J Kidney Dis 2003; 42: 466–473.

12. Jones CA, Francis ME, Eberhardt MS et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002; 39: 445–459.

13. Tapp RJ, Shaw JE, Zimmet PZ et al. Albuminuria is evident in the early stages of diabetes onset: results from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Am J Kidney Dis 2004; 44: 792–798.

14. Coresh J, Selvin E, Stevens LA et al. Prevalence of chronic kidney disease in the United States. JAMA 2007; 298: 2038–2047.

15. Parving HH, Lewis JB, Ravid M et al. DEMAND investigators. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 2006; 69: 2057–2063.

16. Wachtell K, Palmieri V, Olsen MH et al. Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE study. Losartan Intervention for Endpoint Reduction. Am Heart J 2002; 143: 319–326.

17. Böhm M, Thoenes M, Danchin N et al. Association of cardiovascular risk factors with microalbuminuria in hypertensive individuals: the i-SEARCH global study. J Hypertens 2007; 25: 2317–2324.

18. Agrawal B, Berger A, Wolf K et al. Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension. J Hypertens 1996; 14: 223–228.

19. Cerasola G, Mulé G, Nardi E et al. Hypertension, microalbuminuria and renal dysfunction. The Renal Dysfunction in Hypertension (REDHY) study. J Nephrol 2008; 21: 368–373.

20. Leoncini G, Viazzi F, Rosei EA et al. Chronic kidney disease in hypertension under specialist care: the I-DEMAND study. J Hypertens 2010; 28: 2317–2324.

21. de Zeeuw D, Remuzzi G, Parving HH et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004; 110: 921–927.

22. Cerasola G, Cottone S, Mulè G. The progressive pathway of microalbuminuria: from early marker of renal damage to strong cardiovascular risk predictor. J Hypertens 2010; 28: 2357–2369.

23. Basi S, Lewis JB. Microalbuminuria as a target to improve cardiovascular and renal outcomes. Am J Kidney Dis 2006; 47: 927–946.

24. Wolf G, Chen S, Ziyadeh FN. From the periphery of the glomerular capillary wall toward the center of disease: podocyte injury comes of age in diabetic nephropathy. Diabetes 2005; 54: 1626–1634.

25. Ochodnicky P, Henning RH, van Dokkum RP et al. Microalbuminuria and endothelial dysfunction: emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol 2006; 47 (Suppl 2): S151–S162.

26. Rüster C, Wolf G. Renin-angiotensin-aldosterone system and progression of renal disease. J Am Soc Nephrol 2006; 17: 2985–2991.

27. 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: 2–35.

28. Menne J, Chatzikyrkou Ch, Haller H. Microalbuminuria as a risk factor: the influence of renin-angiotensin system blockade. J Hypertens 2010; 28: 1983–1994.

29. Ärnlöv J, Evans JC, Meigs JB et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969–975.

30. Jager A, Kostense PJ, Ruhé HG et al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especia­lly among hypertensive subjects. Five-year follow-up of the Hoorn Study. Arterioscler Thromb Vasc Biol 1999; 19: 617–624.

31. Hillege HL, Fidler V, Diercks GF et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002; 106: 1777–1782.

32. Gerstein HC, Mann JFE, Yi Q et al. HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421–426.

33. Valmadrid CT, Klein R, Moss SE et al. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000; 160: 1093–1100.

34. Wachtell K, Ibsen H, Olsen MH et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 2003; 139: 901–906.

35. Yuyun MF, Dinneen SF, Edwards OM et al. Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy. Diabet Med 2003; 20: 277–282.

36. O‘Hare AM, Hailpern SM, Pavkov ME et al. Prognostic implications of the urinary albumin to creatinine ratio in veterans of different ages with diabetes. Arch Intern Med 2010; 170: 930–936.

37. Berton G, Cordiano R, Palmieri R et al. Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality. Diabetologia 2004; 47: 1511–1518.

38. Berton G, Cordiano R, Mazzuco S et al. Albumin excretion in acute myocardial infarction: A guide for long-term prognosis. Am Heart J 2008; 156: 760–768.

39. Yuyun MF, Khaw KT, Luben R et al. Microalbuminuria and stroke in a British population: the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study. J Intern Med 2004; 255: 247–256.

40. Özyilmaz A, Bakker SJ, de Zeeuw D et al. PREVEND Study Group. Selection on albuminuria enhances the efficacy of screening for cardiovascular risk factors. Nephrol Dial Transplant 2010; 25: 3560–3568.

41. Hallan S, Astor B, Romundstad S et al. Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals: The HUNT II Study. Arch Intern Med 2007; 167: 2490–2496.

42. Chronic Kidney Disease Prognosis Consortium. 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: 2073–2081.

43. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 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). J Hypertens 2007; 25: 1105–1087.

44. Chobanian AV, Bakris GL, Black HR et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

45. Ogihara T, Kikuchi K, Matsuoka H et al. Japanese Society of Hypertension Committee. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2009). Hypertens Res 2009; 32: 3–107.

46. Ruggenenti P, Fassi A, Ilieva AP et al. Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Investigators. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941–1951.

47. Mann JFE, Schmieder RE, Dyal L et al. TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Effect of Telmisartan on Renal Outcomes: A Randomized Trial. Ann Intern Med 2009; 151: 1–10.

48. Bilous R, Chaturvedi N, Sjølie AK et al. Effect of Candesartan on Microalbuminuria and Albumin Excretion Rate in Diabetes: Three Randomized Trials. Ann Intern Med 2009; 151: 11–20.

49. Mauer M, Zinman B, Gardiner R et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J Med 2009; 361: 40–51.

50. Haller H, Ito S, Izzo JL Jr et al. Prevention of microalbuminuria: in type 2 diabetes (Roadmap Trial). J Hypertension 2010; 28: 233.

51. Haller J, Ito S, Izzo JL et al. Prevention of microalbuminuria: Predictors for a good response to olmesartan treatment (Roadmap Trial). J Hypertension 2010; 28: 275.

52. Ritz E, Viberti GC, Ruilope LM et al. Determinants of urinary albumin excretion within the normal range in patients with type 2 diabetes: the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. Diabetologia 2010; 53: 49–57.

53. Mann JF, Schmieder RE, McQueen M et al. ONTARGET investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008; 372: 547–553.

54. Douglas K, O‘Malley PG, Jackson JL. Meta-analysis: the effect of statins on albuminuria. Ann Intern Med 2006; 145: 117–124.

55. Keech A, Simes RJ, Barter P et al. FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9 795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849–1861.

56. Schrader J, Lüders S, Kulschewski A et al. MARPLE Study Group. Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study). J Hypertens 2006; 24: 541–548.

57. Bakris GL, Ruilope L, Locatelli F et al. Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: Results of the IMPROVE trial. Kidney Int 2007; 72: 879–885.

58. Ibsen H, Olsen MH, Wachtell K et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertensive study. Hypertension 2005; 45: 198–202.

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Diabetology Endocrinology Internal medicine

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