microalbuminuria and cardiovascular (CV) risk

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There is evidence from the HOPE study that the presence of albuminuria indicates increased risk for myocardial infarction, stroke, cardiovascular death, congestive heart failure, and all-cause mortality.

Summary results:

  • the association between albuminuria and increaed cardiovascular risk is true in patients with or without diabetes and, in the HOPE study, occurred in those receiving ramipril or placebo
  • the increase in risk began below the threshold concentrations for microalbuminuria used to indicate incipient diabetic nephropathy in patients with diabetes mellitus (albumin/creatinine ratio of below 2mg/mmol)
    outcomes at median 4.5 years with microalbuminuria without microalbuminuriaa adjusted RR (95% CI)
    major cardiovascular events 23% 14% 1.83 (1.64-2.05)
    all-cause mortality 18% 9% 2.09 (1.84-2.38)
    CHF hospital admission 6% 2% 3.23 (2.54-4.10)

Authors of the study point out that many cardiovascular risk factors are associated with microalbuminuria, including smoking, hypertension, dyslipidaemia, hyperhomocystinemia, dietary protein, and markers of acute phase response. There is a need for further research to clearly assess the independent cardiovascular risk that occurs as a result of the presence (and degree) of albuminuria.

Glomerular Filtration and microalbuminuria:

  • evidence from a Norwegian cohort study reveals that the combination of a glomerular filtration rate < 45 ml/min/1.73m^2 and microalbuminuria was a strong predictor of cardiovascular death (2)
    • reduced kidney function and microalbuminuria were risk factors for cardiovascular death, independent of each other and traditional risk factors
  • a US study revealed that moderately decreased estimated GFR and albuminuria independently predict cardiovascular and all-cause mortality in the general population (3)

Reference:

Last reviewed 01/2018

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