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      Albuminuria and hyperhomocysteinemia as cardiovascular risk factors in potentially healthy soldiers: A long-term observation

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          Summary

          Background

          To assess the relations between albuminuria and selected cardiovascular risk factors.

          Material/Methods

          The study population comprised 200 apparently healthy soldiers aged 28.8±8.1, observed for 36 months.

          Results

          Albuminuria was revealed in 9% of the studied group at the beginning of the study and in 12.7% at the end of the observation. Albumins increased from 97.0±61.0 mg/24 hours to 165.0±25.7 mg/24 hours after 36 months of observation. The increase of diastolic blood pressure, body mass, C-reactive protein (CRP), and low-density lipoprotein (LDL) was found in the “albuminuria subgroup” after 3 years of observation. This subgroup also presented significantly higher homocysteine and CRP serum concentrations in comparison with the “non-albuminuria group” in the first phase of the study and after 3 years of follow-up.

          Conclusions

          Albuminuria was found to be a relatively frequent and persistent abnormality in the studied group. The study demonstrated the relationship between the occurrence and the severity of albuminuria and selected biochemical and demographic cardiovascular risk factors. Determination of albuminuria is a useful, early marker of cardiovascular risk in young male professional soldiers.

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          Microalbuminuria in the US population: third National Health and Nutrition Examination Survey.

          Marcel E. Salive, Alison Jones, Danita Byrd-Clark … (2002)
          Microalbuminuria (MA) is associated with adverse health outcomes in diabetic and hypertensive adults. The prevalence and clinical significance of MA in nondiabetic populations is less clear. The purpose of this study was to generate national estimates of the prevalence of MA in the US population. Untimed urinary albumin concentrations (UACs) and creatinine concentrations were evaluated in a nationally representative sample of 22,244 participants aged 6 years and older. Persons with hematuria and menstruating or pregnant women were excluded from analysis. The percent prevalence of clinical proteinuria (UAC > or = 300 mg/L) was similar for males and females. However, the prevalence of MA (urinary albumin-creatinine ratio [ACR], 30 to 299 mg/g) was significantly lower in males (6.1%) compared with females (9.7%). MA prevalence was greater in children than young adults and increased continuously starting at 40 years of age. MA prevalence was greater in non-Hispanic blacks and Mexican Americans aged 40 to 79 years compared with similar-aged non-Hispanic whites. MA prevalence was 28.8% in persons with previously diagnosed diabetes, 16.0% in those with hypertension, and 5.1% in those without diabetes, hypertension, cardiovascular disease, or elevated serum creatinine levels. In adults aged 40+ years, after excluding persons with clinical proteinuria, albuminuria (defined as ACR > or = 30 mg/g) was independently associated with older age, non-Hispanic black and Mexican American ethnicity, diabetes, hypertension, and elevated serum creatinine concentration. MA is common, even among persons without diabetes or hypertension. Age, sex, race/ethnicity, and concomitant disease contribute to the variability of MA prevalence estimates. Copyright 2002 by the National Kidney Foundation, Inc.
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            A multi-marker approach to predict incident CKD and microalbuminuria.

            Joy Larson, Paul F Jacques, Shih-Jen Hwang … (2010)
            Traditional risk factors do not adequately identify individuals at risk for CKD. We related a multi-marker panel consisting of the following seven circulating biomarkers to the incidence of CKD and microalbuminuria (MA) in 2345 participants who attended the sixth Framingham Offspring Study examination (1995 to 1998): C-reactive protein, aldosterone, renin, B-type natriuretic peptide (BNP), plasminogen-activator inhibitor type 1, fibrinogen, and homocysteine. We defined CKD at follow-up (2005 to 2008) as estimated GFR (eGFR) <60 ml/min per 1.73 m²; we defined MA as urine albumin-to-creatinine ratio ≥25 (women) or 17 (men) mg/g on spot urine samples. We identified a parsimonious set of markers related to outcomes adjusting for standard risk factors and baseline renal function, and we assessed their incremental predictive utility. During a mean 9.5-year follow-up, 213 participants developed CKD and 186 developed MA. In multivariable logistic regression models, the multi-marker panel was associated with incident CKD (P < 0.001) and MA (P = 0.003). Serum homocysteine and aldosterone both were significantly associated with CKD incidence, and log-transformed aldosterone, BNP, and homocysteine were significantly associated with incident MA. Biomarkers improved risk prediction as measured by improvements in the c-statistics for both CKD and MA and by a 7% increase in net risk reclassification. In conclusion, circulating homocysteine, aldosterone, and BNP provide incremental information regarding risk for incident CKD and MA beyond traditional risk factors.
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              Racial and ethnic differences in microalbuminuria prevalence in a diabetes population: the pathways study.

              E J Ludman, Michael Von Korff, Wayne J Katon … (2004)
              The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Sci Monit
                Journal ID (iso-abbrev): Med. Sci. Monit
                Journal ID (publisher-id): Medical Science Monitor
                Title: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1234-1010
                ISSN (Electronic): 1643-3750
                Publication date Collection: 2012
                Publication date (Electronic): 17 December 2012
                Volume: 18
                Issue: 12
                Pages: CR771-CR776
                Affiliations
                Department of Internal Medicine, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
                Author notes
                Grzegorz Kade, Department of Internal Medicine, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland, e-mail: gkade@ 123456wim.mil.pl
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                Publisher ID: 883638
                DOI: 10.12659/MSM.883638
                PMC ID: 3560811
                PubMed ID: 23241651
                SO-VID: 0e1fb63a-ee1e-4873-8e5f-4af63e4d4501
                Copyright © © Med Sci Monit, 2011
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 27 September 2012
                Date accepted : 12 November 2012
                Categories
                Subject: Clinical Research

                Keywords: albuminuria,hyperhomocysteinemia,cardiovascular risk factors
                Data availability:
                Keywords: albuminuria, hyperhomocysteinemia, cardiovascular risk factors

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