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Govardi E, Yulianda D, Habib F, Pakpahan C. Microalbuminuria and mortality in individuals with coronary heart disease: A meta-analysis of a prospective study. Indian Heart J 2023; 75:229-235. [PMID: 37207828 PMCID: PMC10421992 DOI: 10.1016/j.ihj.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
AIM Microalbuminuria has been elevated as an outcome predictor in cardiovascular medicine. However, due to the small number of studies investigating the association of microalbuminuria and mortality in the coronary heart disease (CHD) population, the prognosis value of microalbuminuria in CHD remains under debate. The objective of this meta-analysis was to investigate the relationship between microalbuminuria and mortality in individuals with CHD. METHOD A comprehensive literature search was performed using Pubmed, EuroPMC, Science Direct, and Google Scholar from 2000 to September 2022. Only prospective studies investigating microalbuminuria and mortality in CHD patients were selected. The pooled effect estimate was reported as risk ratio (RR). RESULTS 5176 patients from eight prospective observational studies were included in this meta-analysis. Individuals with CHD have a greater overall risk of all-cause mortality (ACM) [rR = 2.07 (95% CI = 1.70-2.44); p = 0.0003; I2 = 0.0%] as well as cardiovascular mortality (CVM) [rR = 3.23 (95% CI = 2.06-4.39), p < 0.0001; I2 = 0.0%]. Subgroup analysis based on follow-up duration and a subset of CHD patients were similarly associated with an increased risk of ACM. CONCLUSION This meta-analysis indicates that microalbuminuria is associated with a higher risk of mortality in individuals with CHD. Microalbuminuria can serve as a predictor of poor outcomes in CHD patients.
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Affiliation(s)
- Ericko Govardi
- Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia.
| | - Dicky Yulianda
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Faisal Habib
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Cennikon Pakpahan
- Department of Biomedicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Martinez-Arroyo O, Ortega A, Flores-Chova A, Sanchez-Garcia B, Garcia-Garcia AB, Chaves FJ, Martin-Escudero JC, Forner MJ, Redon J, Cortes R. High miR-126-3p levels associated with cardiovascular events in a general population. Eur J Intern Med 2023; 113:49-56. [PMID: 37080818 PMCID: PMC10271715 DOI: 10.1016/j.ejim.2023.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Endothelial dysfunction is a forerunner of atherosclerosis, leading to cardiovascular disease, and albuminuria is a marker of endothelial dysfunction. Circulating levels of microRNAs are emerging as potential biomarkers for cardiovascular disease. Here we estimate the predictive value of a plasma microRNAs signature associated with albuminuria in the incidence of cardiovascular events. METHODS Plasma microRNAs quantified in hypertensive patients by next generation sequencing were validated in a cohort of patients and controls by real-time quantitative PCR. The microRNAs found to be associated with albuminuria were analysed for their prognostic value in predicting cardiovascular events incidence on a retrospective, population-based study (Hortega Study), using Cox proportional hazard models. RESULTS A plasma microRNA profile was identified in the discovery cohort (n = 48) associated with albuminuria and three microRNAs (miR-126-3p, miR-1260b and miR-374a-5p) were confirmed in the validation cohort (n = 98). The microRNA signature discriminates urinary albumin excretion at baseline (n = 1025), and predicts the incidence of cardiovascular events and coronary heart disease and stroke in a general population retrospective study within a 14-year follow-up (n = 926). High miR-126-3p levels were associated with a shorter time free of both cardiovascular events (HR=1.48, (1.36-1.62), p < 0.0001), as well as coronary artery disease and stroke combined (HR=2.49, (2.19-2.83), p < 0.0001). CONCLUSIONS An increased plasma microRNAs profile was identified in hypertensive patients with albuminuria. Increased miR-126-3p suggest it may serve as a prognostic marker for cardiovascular events in a long-term general population. Further studies will assess the potential role of miR-126-3p as a guide for the status of endothelial dysfunction.
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Affiliation(s)
- Olga Martinez-Arroyo
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain
| | - Ana Ortega
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain; CIBERCV (CIBER of Cardiovascular Diseases), Madrid, Spain.
| | - Ana Flores-Chova
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain
| | - Belen Sanchez-Garcia
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain
| | | | - Felipe J Chaves
- CIBERDEM (CIBER of Diabetes and Metabolic Diseases), Madrid, Spain; Unit of Genomics and Diabetes, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain
| | - Juan C Martin-Escudero
- Department of Internal Medicine, Rio Hortega Universitary Hospital, Valladolid, Spain; Department of Medicine, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Maria Jose Forner
- Department of Internal Medicine, University Hospital Clinico, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Josep Redon
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain; Department of Internal Medicine, University Hospital Clinico, Valencia, Spain; CIBEROBN (CIBER of Obesity and Nutrition Physiopathology), Madrid, Spain
| | - Raquel Cortes
- Cardiometabolic and Renal Risk Research Group, Biomedical Research Institute of Hospital Clinico de Valencia INCLIVA, Valencia, Spain.
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D'Errico MM, Piscitelli P, Mirijello A, Santoliquido M, Massa V, Salvatori M, Vigna C, Vendemiale G, Aucella F, Pontremoli R, De Cosmo SA. Low eGFR and albuminuria independently predict all-cause mortality in high-risk subjects undergoing coronary arteriography. Intern Emerg Med 2022; 17:695-701. [PMID: 34609678 DOI: 10.1007/s11739-021-02851-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/12/2021] [Indexed: 12/19/2022]
Abstract
Individuals with Chronic Kidney Disease (CKD) are at high risk for cardiovascular morbidity and mortality. The aim of this study was to examine the relationship between renal dysfunction and all-cause mortality in a sample of subjects undergoing coronary angiography (CA). We evaluated 1017 subjects who consecutively underwent CA. Glomerular filtration rate (eGFR) was estimated by CKD-EPI and urinary albumin excretion reported as urinary albumin-to-creatinine ratio. Vital status was ascertained by interrogating the Italian Health Card Database. One-thousand-seventeen subjects (759 M/258F) were enrolled into the study from 2016 to 2018. One-hundred-fourteen deaths occurred during a median follow-up of 44 months. The whole population was divided in two subgroups according to the presence/absence of low eGFR (i.e. < 60 ml/min/1.73 m2). Subjects with low baseline eGFR had a worse clinical profile than subjects with preserved kidney function. The risk of death in subjects with eGFR < 60 ml/min/1.73 m2 was almost three times higher than in subjects with preserved kidney function: fully adjusted HR 2.70 (95% CI 1.56-4.67). The presence of albuminuria also predicted a high risk of death: fully adjusted HR 2.09 (95% CI 1.17-3.73) and HR 4.26 (95% CI 2.18-8.33), microalbuminuria or macroalbuminuria, respectively, being normoalbuminuria the reference group. Again, the increased risk remained significant after adjusting for several potential confounders. In conclusion, kidney disease measures (i.e. low eGFR or albuminuria) independently predict increased risk for all-cause death in a large sample of subjects undergoing CA. These results have a relevant clinical impact.
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Affiliation(s)
- Maria Maddalena D'Errico
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Pamela Piscitelli
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Mariateresa Santoliquido
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
- Geriatrics Residency School, University of Foggia, Foggia, FG, Italy
| | - Valentina Massa
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Mauro Salvatori
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | | | - Filippo Aucella
- Unit of Nephrology and Hemodialysis, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy
| | - Roberto Pontremoli
- Università Degli Studi and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Salvatore A De Cosmo
- Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale dei Cappuccini snc, 71013, San Giovanni Rotondo, FG, Italy.
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Mirna M, Topf A, Wernly B, Rezar R, Paar V, Jung C, Salmhofer H, Kopp K, Hoppe UC, Schulze PC, Kretzschmar D, Schneider MP, Schultheiss UT, Sommerer C, Paul K, Wolf G, Lichtenauer M, Busch M. Novel Biomarkers in Patients with Chronic Kidney Disease: An Analysis of Patients Enrolled in the GCKD-Study. J Clin Med 2020; 9:jcm9030886. [PMID: 32213894 PMCID: PMC7141541 DOI: 10.3390/jcm9030886] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic kidney disease (CKD) and cardiovascular diseases (CVD) often occur concomitantly, and CKD is a major risk factor for cardiovascular mortality. Since some of the most commonly used biomarkers in CVD are permanently elevated in patients with CKD, novel biomarkers are warranted for clinical practice. Methods: Plasma concentrations of five cardiovascular biomarkers (soluble suppression of tumorigenicity (sST2), growth differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor-binding protein 2 (IGF-BP2), and soluble urokinase plasminogen activator receptor) were analyzed by means of enzyme-linked immunosorbent assay (ELISA) in 219 patients with CKD enrolled in the German Chronic Kidney Disease (GCKD) study. Results: Except for sST2, all of the investigated biomarkers were significantly elevated in patients with CKD (2.0- to 4.4-fold increase in advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² body surface area (BSA)) and showed a significant inverse correlation with eGFR. Moreover, all but H-FABP and sST2 were additionally elevated in patients with micro- and macro-albuminuria. Conclusions: Based on our findings, sST2 appears to be the biomarker whose diagnostic performance is least affected by decreased renal function, thus suggesting potential viability in the management of patients with CVD and concomitant CKD. The predictive potential of sST2 remains to be proven in endpoint studies.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Richard Rezar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Hermann Salmhofer
- Department of Internal Medicine I, Division of Nephrology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Markus P. Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Ulla T. Schultheiss
- Department of Medicine IV – Nephrology and Primary Care, Institute of Genetic Epidemiology, Medical Center–University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany;
| | - Claudia Sommerer
- Department of Nephrology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Katharina Paul
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Gunter Wolf
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
- Correspondence:
| | - Martin Busch
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
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Impaired glomerular filtration rate, high grade albuminuria and associated factors among adult patients admitted to tertiary Hospital in Ethiopia. BMC Nephrol 2018; 19:345. [PMID: 30509207 PMCID: PMC6278145 DOI: 10.1186/s12882-018-1153-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Chronic Kidney Disease (CKD), the worldwide Public Health problem, is also one of the rising non-communicable diseases in low and middle-income countries. Its early detection and treatment using readily available, inexpensive therapies can slow or prevent progression to end-stage renal disease. Hence, this study was aimed at assessing impaired estimated glomerular filtration rate (eGFR), high grade albuminuria, and associated factors among adult patients admitted to Jimma University Medical Center in South west Ethiopia. Methods Hospital based cross sectional study was conducted from November 1, 2016 to April 30, 2017. Consecutive sampling method was used to select study participants. Logistic regression analysis was conducted to generate factors associated with impaired estimated GFR and albuminuria. A P-value of < 0.05 was considered statistically significant. Results The study involved 422 patients admitted to Jimma University Medical Center who had at least one test result for urinalysis and serum creatinine level during the study period. Fifty two (12.3%) of the study subjects had high grade albuminuria, 19.2, 19.4, and 32.7% had impaired estimated glomerular filtration rate according to Modification of Diet in Renal Disease (MDRD-4), Chronic Kidney Disease Epidemiology (CKD-EPI), and Cockcroft-Gault (CG) equations respectively. Old age (AOR = 2.4;95%CI:1.4–4.01), male sex (AOR = 2.1;95%CI:1.16–3.7), and hypertension (AOR = 2.23; 95%CI:1.24–4.01) were independently associated with impaired eGFR using one of the two equations while diabetes mellitus (AOR = 2.8; 95%CI:1.33–5.82) and BP measurement above optimal (AOR = 4.7; 95%CI:1.9–11.53) were associated with high grade albuminuria. Conclusions High grade albuminuria and impaired eGFR were found in significant proportion of adults admitted to the hospital for various medical conditions. Old age, hypertension, diabetes mellitus and male gender were independently associated with these alterations. These findings necessitate routine urinalysis and estimation of GFR for all hospitalized adults with known CKD risk factors.
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D'Errico MM, Mangiacotti A, Graziano D, Massa V, Piscitelli P, Vendemiale G, Viazzi F, Pontremoli R, Russo A, Marchese N, Vigna C, De Cosmo S. Kidney disease measures are associated with the burden of coronary atherosclerosis, independently of diabetes. Acta Diabetol 2017; 54:1065-1068. [PMID: 28730567 DOI: 10.1007/s00592-017-1022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Maddalena D'Errico
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Antonio Mangiacotti
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Daniele Graziano
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Valentina Massa
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Pamela Piscitelli
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Gianluigi Vendemiale
- Chair of Internal Medicine and Postgraduate School of Geriatrics, University of Foggia, Foggia, Italy
| | - Francesca Viazzi
- Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Roberto Pontremoli
- Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Aldo Russo
- Cardiololgy Unit, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Nicola Marchese
- Cardiololgy Unit, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Carlo Vigna
- Cardiololgy Unit, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy.
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