2010, Number 4
<< Back Next >>
MEDICC Review 2010; 12 (4)
Albuminuria as a marker of kidney and cardio-cerebral vascular damage. Isle of Youth Study (ISYS), Cuba
Herrera R, Almaguer M, Chipi J, Martínez O, Bacallao J, Rodríguez N, Abreu MC, Fariña O, Roche MC
Language: English
References: 45
Page: 20-26
PDF size: 210.10 Kb.
ABSTRACT
Introduction The disease complex comprised of atherosclerosis, chronic kidney disease (CKD) and other associated chronic vascular diseases is the leading cause of mortality worldwide. Microalbuminuria is a marker for vascular damage in the heart, kidney and brain. This paper presents selected findings of the clinical-epidemiological Isle of Youth Study (ISYS) of markers for kidney and vascular damage from chronic vascular diseases and their common risk factors in total population, focusing on Phase 2 reassessment (in 2010) of Phase 1
(2004 to 2006) results.
Objectives Update the prevalence of risk factors in the study population aged ≥ 20 years (adult population). Confirm presence of microalbuminuria in at-risk adults diagnosed as presumptive positives in Phase I. Evaluate association between microalbuminuria and
selected risk factors.
Methods Of 3779 adults positive for microalbuminuria in ISYS Phase 1, 73.1% were reevaluated. The risk-factor questionnaire was re-administered and blood pressure, weight and height were measured. Blood was tested for creatinine, glycemia, cholesterol
and triglycerides. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Albuminuria was measured in urine using Micral-Test (Germany) and albumin/creatinine ratio (ACR) by nephelometry. This paper uses ACR as the
reference for analyzing risk factor associations. Double-entry tables were developed to analyze association among microalbuminuria, risk factors and co-morbidities.
Results Most prevalent risks were hypertension, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), excess weight and hypertriglyceridemia.
Microalbuminuria was confirmed in 18% of cases, using
the same test. Elevated prevalence of microalbuminuria was positively associated with advancing age, male sex, underweight, smoking, NSAID use, dyslipidemia, hypertension, diabetes, heart disease and stroke.
Conclusions The at-risk cohort studied presented low levels of confirmation for positive microalbuminuria. Positive microalbuminuria stratified individuals at greatest risk, except for obesity.
REFERENCES
Brown WW. Vascular Disease and Chronic Kidney Disease. Editorial. Adv Chronic Kidney Dis. 2008 Oct;15(4):333–4.
Fernández-Britto JE. Aterosclerosis y obesidad. In: Alfonzo JP, editor. Obesidad. Epidemia del siglo XXI. Havana: Editorial Científico-Técnica; 2008. p.175–92.
U.S. Renal Data Systems. USRDS 2007 Annual Data Report: Atlas of End Stage Renal Disease in the United States. National Institutes of Health, NIDDK, Bethesda, MD, 2007. Incidence & Prevalence. Am J Kidney Dis. 2010 Jan;55(1 Suppl):S231–40.
Bello AK, Nwankwo E, El-Nahas AM. Prevention of chronic kidney disease: A global challenge. Kidney Int Suppl. 2005 Sep;(98):S11–7.
Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: A new paradigm. Am J Kidney Dis. 2000 Apr;35(4 Suppl 1):S117–31.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296– 305.
Ritz E, McClellan WM. Overview: Increased Cardiovascular Risk in Patients with Minor Renal Dysfunction: An Emerging Issue with Far-Reaching Consequences. J Am Soc Nephrol. 2004 Mar;15(3):513–6.
Dirks JH, Zeeuw D, Agarwal SK, Atkins RC, Correa-Rotter R, D’Amico G, et al. Prevention of chronic kidney and vascular disease: Toward global health equity–The Bellagio 2004 Declaration. Kidney Int Suppl. 2005 Sep;(98):S1–6.
Coresh J, Stevens LA, Levey AS. Chronic kidney disease is common: What do we do next? Nephrol Dial Transplant. 2008 Apr;23(4):1122–5.
Stevens LA, Levey AS. Current Status and Future Perspectives for CKD Testing. Am J Kidney Dis. 2009 Mar;53(3 Suppl 3):S17–26.
Hallan SI, Stevens P. Screening for chronic kidney disease: which strategy? J Nephrol. 2010 Mar– Apr;23(2):147–55.
de Zeew D. Albuminuria, not only a cardiovascular/ renal risk marker, but also a target for treatment? Kidney Int Suppl. 2004 Nov;(92):S2–6.
de Jong PE, Gansevoort RT. Albuminuria in non-primary renal disease: risk marker rather than risk factor. Nephrol Dial Transplant. 2010 Mar;25(23):656–8.
Remuzzi G, Weening JJ. Albuminuria as early test for vascular disease. Lancet. 2005 Feb 12– 18;365(9459):556–7.
Herrera R, Almaguer M, Chipi J, Toirac X, Martinez O, Castellanos O, et al. Detection of markers of cardiovascular and renal risk in Cuba: Isle of Youth Study (ISYS). Nephron Clin Pract. Forthcoming 2011.
Almaguer M, Herrera R, Chipi J, Toirac X, Castellanos O, Bacallao J. Design and methodology of the Isle of Youth community-based epidemiological study of CKD, cardio-cerebral vascular disease, hypertension, and diabetes mellitus (ISYS). MEDICC Rev. 2007;9(1):23–30.
Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. National Kidney Foundation: Kidney Disease Outcomes Quality Initiative. Am J Kidney Dis. 2002;39(2 Suppl 1):S7–256.
Chobaniam AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003 May 21;289(19):2560–72.
American Diabetes Association. Standards of medical care in diabetes–2006. Diabetes Care. 2006 Jan;29 Suppl 1:S4–42.
Levey AS, Eckardt K, TsukamotoY, Levin A, Coresh J, Rossert J, et al. [Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)]. Kidney Int. 2005 Jun;67(6):2089–100.
Alfonzo JP. Definiciones de sobrepeso y obesidad. In: Alfonzo JP, editor. Obesidad. Epidemia del siglo XXI. Havana: Editorial Científico-Técnica; 2008. p. 175–92.
Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, et al. Prevalence of kidney damage in Australian adults: The AusDiab Kidney Study. J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S131–8.
Hillege HL, Janssen WMT, Bak AAA, Diercks GFH, Grobbee DE, Crijins HJGM, et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med. 2001 Jun;249(6):519–26.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of Chronic Kidney Disease and Decreased Renal Function in the Adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003 Jan;41(1):1–12.
El Nahas M. Cardio-Kidney-Damage: a unifying concept. Kidney Int. 2010 Jul;78(1):14–8.
Glassock RJ, Winearls C. Diagnosing chronic kidney disease. Curr Opin Nephrol Hypertens. 2010 Mar;19(2):123–8. Review.
Hogan M. KDIGO Conference Proposes Changes to CKD Classification, but not to the Definition. Nephrology Times. 2009 Dec;2(12):9–10.
Burgos-Calderón R, Depine S. Systematic approach for the management of chronic kidney disease: moving beyond chronic kidney disease classification. Curr Opin Nephrol Hypertens. 2010 Mar;19(2):208–13.
Abaterusso C, Lupo A, Ortalda V, De Biase V, Pani A, Muggeo M, et al. Treating Elderly People with Diabetes and Stages 3 and 4 Chronic Kidney Disease. Clin J Am Soc Nephrol. 2008 Jul;3(4):1185– 94. Epub 2008 Apr 16.
Otero A, de Francisco A, Gayoso P, García F; EPIRCE Study Group. Prevalence of chronic renal disease in Spain: Results of the EPIRCE study. Nefrologia. 2010;30(1):78–86.
Hamer RA, El Nahas AM. The burden of chronic kidney disease is rising rapidly worldwide. BMJ. 2006 Mar 11;332 (7541):563–4.
Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: A 10-year populationbased study of the effects of gender and age. Kidney Int. 2006 Jan;69(2):375–82.
Iseki K. Screening for renal disease—what can be learned from the Okinawa experience. Nephrol Dial Transplant. 2006 Apr;21(4):839–43. Epub 2006 Feb 16.
Registro Estadístico de la Oficina del Centro Coordinador Nacional del Programa Enfermedad Renal Crónica, Diálisis y Transplante Renal. Instituto de Nefrología. Havana: Ministry of Public Health (CU); 2009.
Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J. Risk factors for Chronic Kidney Disease: A Prospective Study of 23,534 Men and Women in Washington County, Maryland. J Am Soc Nephrol. 2003 Nov;14(11):2934–41.
Glassock RJ, Winearls C. An epidemic of chronic kidney disease: fact or fiction? Nephrol Dial Transplant. 2008 Apr;23(4):1117–21.
Wanner C, Ritz E. Reducing lipids for CV protection in CKD patients—current evidence. Kidney Int Suppl. 2008 Dec;74(111):S24–8.
Orth SR. Smoking—a renal risk factor. Nephron. 2000 Sep;86(1):12–26.
Whelton A. Nephrotoxicity of nonsteroidal antiinflammatory drugs: physiologic foundations and clinical implications. Am J Med. 1999 May 31;106(5B):13S–24S.
Segura J, Campo C, Ruilope LM. Effect of proteinuria and glomerular filtration rate on cardiovascular risk in essential hypertension. Kidney Int Suppl. 2004 Nov;(92):S45–9.
Mann JF, Yi QL, Gerstein HC. Albuminuria as a predictor of cardiovascular and renal outcomes in people with known atherosclerotic cardiovascular disease. Kidney Int Suppl. 2004 Nov;(92):S59–62.
Atkins RC, Zimmet P. Diabetic Kidney disease: act now or pay later. Kidney Int. 2010 Mar;77(5):378– 80.
Levin A, Rocco M. Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007 Feb;49(2 Suppl 2):S13–9.
Weiner DE. The Cognition-Kidney Disease Connection: Lessons From Population-Based Studies in de United States. Am J Kidney Dis. 2008 Aug;52(2):201–4.
Barzilay JI, Fitzpatrick AL, Luchsinger J, Yasar S, Bernik C, Jenny NS, et al. Albuminuria and Dementia in the Elderly: A Community Study. Am J Kidney Dis. 2008 Aug;52(2):216–26.