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Bae J, Lee BW. Significance of Diabetic Kidney Disease Biomarkers in Predicting Metabolic-Associated Fatty Liver Disease. Biomedicines 2023; 11:1928. [PMID: 37509567 PMCID: PMC10377561 DOI: 10.3390/biomedicines11071928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Metabolic-associated fatty liver disease (MAFLD) and diabetic kidney disease (DKD) share various pathophysiological factors, and epidemiological evidence suggests that these two diseases are associated. Albuminuria and the estimated glomerular filtration rate, which are conventional biomarkers of DKD, are reportedly associated with the risk or severity of MAFLD. Recently, novel DKD biomarkers reflecting renal tubular injury have been introduced to complement conventional DKD markers. In this article, we looked at previous studies that showed an association between MAFLD and DKD, and also reviewed the significance of DKD biomarkers as predictive risk factors for MAFLD.
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Affiliation(s)
- Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Adeva-Andany MM, Fernández-Fernández C, Funcasta-Calderón R, Ameneiros-Rodríguez E, Adeva-Contreras L, Castro-Quintela E. Insulin Resistance is Associated with Clinical Manifestations of Diabetic Kidney Disease (Glomerular Hyperfiltration, Albuminuria, and Kidney Function Decline). Curr Diabetes Rev 2022; 18:e171121197998. [PMID: 34789129 DOI: 10.2174/1573399818666211117122604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
Abstract
Clinical features of diabetic kidney disease include glomerular hyperfiltration, albuminuria, and kidney function decline towards End-Stage Kidney Disease (ESKD). There are presently neither specific markers of kidney involvement in patients with diabetes nor strong predictors of rapid progression to ESKD. Serum-creatinine-based equations used to estimate glomerular filtration rate are notoriously unreliable in patients with diabetes. Early kidney function decline, reduced glomerular filtration rate, and proteinuria contribute to identifying diabetic patients at higher risk for rapid kidney function decline. Unlike proteinuria, the elevation of urinary albumin excretion in the range of microalbuminuria is frequently transient in patients with diabetes and does not always predict progression towards ESKD. Although the rate of progression of kidney function decline is usually accelerated in the presence of proteinuria, histological lesions of diabetes and ESKD may occur with normal urinary albumin excretion. No substantial reduction in the rate of ESKD associated with diabetes has been observed during the last decades despite intensified glycemic control and reno-protective strategies, indicating that existing therapies do not target underlying pathogenic mechanisms of kidney function decline. Very long-term effects of sodium-glucose transporters- 2 inhibitors and glucagon-like peptide-1 analogs remain to be defined. In patients with diabetes, glucagon secretion is typically elevated and induces insulin resistance. Insulin resistance is consistently and strongly associated with clinical manifestations of diabetic kidney disease, suggesting that reduced insulin sensitivity participates in the pathogenesis of the disease and may represent a therapeutic objective. Amelioration of insulin sensitivity in patients with diabetes is associated with cardioprotective and kidney-protective effects.
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Affiliation(s)
- María M Adeva-Andany
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | | | | | | | | | - Elvira Castro-Quintela
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Effects of low skeletal muscle mass and sarcopenic obesity on albuminuria: a 7-year longitudinal study. Sci Rep 2020; 10:5774. [PMID: 32238873 PMCID: PMC7113302 DOI: 10.1038/s41598-020-62841-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/19/2020] [Indexed: 12/25/2022] Open
Abstract
We aimed to identify the association between low skeletal muscle, sarcopenic obesity, and the incidence of albuminuria in the general population using a longitudinal study. Data from 29,942 subjects who underwent two or more routine health examinations from 2006 to 2013 were retrospectively reviewed. Relative skeletal muscle mass was presented using the skeletal muscle mass index (SMI), a measure of body weight-adjusted appendicular skeletal muscle mass estimated by bioelectrical impedance analysis. The cumulative incidence of albuminuria was 981 (3.3%) during the 7-year follow-up period. The hazard ratio of incident albuminuria was 1.44 (95% CI: 1.22–1.71, p for trend <0.001) in the lowest SMI tertile relative to the highest SMI tertile after multivariable adjustment. After additionally adjusting for general and central obesity, the hazard ratio was 1.35 (95% CI: 1.13–1.61, p for trend = 0.001) and 1.30 (95% CI: 1.08–1.56, p for trend = 0.003), respectively. Furthermore, the risk of developing albuminuria was much higher in the sarcopenic obesity group (HR: 1.49, 95% CI: 1.21–1.81, p for trend <0.001) compared to the other groups. Sarcopenic obesity, as well as low skeletal muscle, may lead to albuminuria in general populations.
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Han E, Lee YH, Kim G, Kim SR, Lee BW, Kang ES, Ahn CW, Cha BS. Sarcopenia is associated with albuminuria independently of hypertension and diabetes: KNHANES 2008-2011. Metabolism 2016; 65:1531-40. [PMID: 27621188 DOI: 10.1016/j.metabol.2016.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Although sarcopenia is associated with metabolic disorders, its influence on albuminuria has not been determined. The aim of this study was to identify the relationship between sarcopenia and albuminuria in the general population. METHODS This was a population-based, cross-sectional study using a nationally representative sample of 2326 subjects aged ≥20years from the Korea National Health and Nutrition Examination Surveys of 2008-2011. Appendicular skeletal muscle (ASM) measured by dual-energy X-ray absorptiometry was used to assess sarcopenia, which was defined as ASM divided by body mass index, as recommended by the international consensus meeting of the National Institutes of Health. Albuminuria was defined as an albumin-to-creatinine ratio of ≥30mg/g using random spot urine samples. RESULTS A total of 385 (16.5%) subjects were classified as having albuminuria. Sarcopenic subjects showed a higher proportion of albuminuria than subjects without sarcopenia (odds ratios [ORs]=2.17-3.26, all P<0.05) after stratification based on the presence of hypertension, diabetes, or metabolic syndrome and a higher homeostasis model assessment of insulin resistance (all P<0.001). The albuminuria risk was comparable between insulin-sensitive subjects with sarcopenia and insulin-resistant subjects with preserved muscle mass. A multiple logistic regression analysis also demonstrated that sarcopenia was independently associated with albuminuria (OR=1.61, 95% confidence interval [CI]=1.04-2.48, P<0.05). The association between sarcopenia and albuminuria remained strong in the elderly population (ORs=1.80-2.68, P<0.05), whereas it lost its significance in the younger age group. Furthermore, the risk of albuminuria was much higher in sarcopenic obese subjects than in other groups (OR=4.90, 95% CI=3.23-7.43, P<0.001). CONCLUSIONS Sarcopenia was associated with an increased risk of albuminuria independent of hypertension, diabetes, and metabolic syndrome. Sarcopenia and obesity had a synergistic impact on the increased risk of albuminuria. This suggests that sarcopenic obesity as well as sarcopenia alone may be considered as novel risk factors for albuminuria.
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Affiliation(s)
- Eugene Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Woo Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Noh HM, Kim UY, Park YS, Song YR, Oh HY, Park KH, Paek YJ, Roh YK, Song HJ. Sex differences in the association between obesity and albuminuria among Korean adults: a cross-sectional study using the Korea National Health and Nutrition Examination Survey data. Clin Exp Nephrol 2016; 21:27-34. [PMID: 26902522 PMCID: PMC5283500 DOI: 10.1007/s10157-016-1238-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
Background The association between obesity and albuminuria in the general population remains unclear. We aimed to identify the association between obesity and albuminuria as well as sex differences regarding the associations using several obesity indices, including waist circumference (WC), body mass index (BMI), and waist-to-height ratio (WHR). Methods This study included 3841 subjects (1730 males and 2111 females; age 20–80 years) who participated in the Fifth Korea National Health and Nutrition Examination Survey conducted in 2011. Subjects with hypertension, diabetes, renal failure, or a malignant tumor and those who were pregnant or menstruating were excluded. Albuminuria was defined as a urinary albumin-to-creatinine ratio ≥30 mg/g. Anthropometric parameters were categorized into sex-specific quartiles. Logistic regression models were used to assess the associations between each anthropometric parameter and albuminuria. Results All of the obesity indices of the fourth quartile group of females showed a twofold higher risk for albuminuria than the second quartile group, and it was persistently significant after adjusting for age, smoking, and physical activity. After further adjustment for high blood pressure and impaired fasting glucose and triglyceride levels, WC and BMI of the fourth quartile group of females still showed a significantly higher risk for albuminuria than the second quartile group (odds ratios 1.96 and 2.24; 95 % confidence intervals 1.03–3.74 and 1.15–4.37). None of the associations between albuminuria and the obesity indices were significant in males. Conclusion Higher WC and BMI were significantly associated with the risk of albuminuria among females, but not males. Electronic supplementary material The online version of this article (doi:10.1007/s10157-016-1238-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 431-796, Republic of Korea
| | - Un-Young Kim
- Daejeon Woori Spine Hospital, Daejeon, Republic of Korea
| | - Yong Soon Park
- Department of Family Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Young Rim Song
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Hye-Young Oh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 431-796, Republic of Korea
| | - Kyung-Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 431-796, Republic of Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 431-796, Republic of Korea
| | - Yong Kyun Roh
- Department of Family Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 431-796, Republic of Korea.
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Chen CC, Susanto H, Chuang WH, Liu TY, Wang CH. Higher serum betatrophin level in type 2 diabetes subjects is associated with urinary albumin excretion and renal function. Cardiovasc Diabetol 2016; 15:3. [PMID: 26739836 PMCID: PMC4704426 DOI: 10.1186/s12933-015-0326-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Betatrophin is a newly identified liver-derived hormone that is associated with glucose homeostasis and lipid metabolism. Although dysregulated lipid metabolism results in diabetic nephropathy (DN) development in patients with type 2 diabetes mellitus (T2DM), it is not understood whether betatrophin is associated with urinary albumin excretion and renal function. METHODS Based on albumin/creatinine ratio (ACR), 109 T2DM patients were divided into normoalbuminuria (ACR <30 mg/g), microalbuminuria (ACR between 30 and 300 mg/g), and macroalbuminuria (ACR > 300 mg/g). Serum betatrophin levels of 109 T2DM patients and 32 healthy subjects were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS Serum level of betatrophin was significantly increased in T2DM patients with normoalbuminuria, microalbuminuria, and macroalbuminuria as compared with healthy subjects (P < 0.001). Serum betatrophin level was positively correlated with sex, duration of diabetes, systolic blood pressure (SBP), body mass index (BMI), ACR, and triglyceride, whereas it was inversely correlated with estimated glomerular filtration rate (eGFR), total cholesterol, and high-density lipoprotein cholesterol (HDL-C) (P < 0.001). Furthermore, multivariate regression analysis showed the betatrophin was significantly and positively independent with triglyceride and low-density lipoprotein cholesterol (LDL-C) (P < 0.05), whereas it was inversely independent with eGFR, total cholesterol, and low-density lipoprotein cholesterol (HDL-C) (P < 0.05). In addition, the betatrophin had higher odds of having DN [odds ratio (OR) = 5.65, 95 % confidence interval (CI) 2.17-14.57, P < 0.001]. CONCLUSION Betatrophin is significantly increased in T2DM patients with different stages of albuminuria. Betatrophin may be a novel endocrine regulator involved in DN development.
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Affiliation(s)
- Chang-Chiang Chen
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Hendra Susanto
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Wen-Han Chuang
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Ta-Yu Liu
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Chih-Hong Wang
- Department of Biological Science and Technology, National Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan.
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Rao A, Pandya V, Whaley-Connell A. Obesity and insulin resistance in resistant hypertension: implications for the kidney. Adv Chronic Kidney Dis 2015; 22:211-7. [PMID: 25908470 DOI: 10.1053/j.ackd.2014.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/08/2014] [Accepted: 12/19/2014] [Indexed: 12/12/2022]
Abstract
There is recognition that the obesity epidemic contributes substantially to the increasing incidence of CKD and resistant hypertension (HTN). The mechanisms by which obesity promotes resistance are an area of active interest and intense investigation. It is thought that increases in visceral adiposity lead to a proinflammatory, pro-oxidative milieu that promote resistance to the metabolic actions of insulin. This resistance to insulin at the level of skeletal muscle tissue impairs glucose disposal/utilization through actions on the endothelium that include vascular rarefaction, reductions in vascular relaxation, and vascular remodeling. Insulin resistance derived from increased adipose tissue and obesity has system-wide implications for other tissue beds such as the kidney that affects blood pressure regulation. The additional autocrine and paracrine activities of adipose tissue contribute to inappropriate activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system that promote kidney microvascular remodeling, stiffness, and sodium (Na(+)) retention that in turn promote HTN and in the CKD patient, resistance. In this review, we will summarize the important mechanisms that link obesity to CKD as they relate to resistant HTN.
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Zhang Y, Lee ET, Howard BV, Best LG, Umans JG, Yeh J, Wang W, Yeh F, Ali T, Devereux RB, de Simone G. Insulin resistance, incident cardiovascular diseases, and decreased kidney function among nondiabetic American Indians: the Strong Heart Study. Diabetes Care 2013; 36:3195-200. [PMID: 23735722 PMCID: PMC3781520 DOI: 10.2337/dc12-2368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Prevalence of insulin resistance is high in the American Indian population, likely as a result of the high prevalence of obesity. This condition may be influential for clinical outcomes such as cardiovascular disease (CVD) and decreased kidney function. RESEARCH DESIGN AND METHODS Normal glucose tolerant (NGT) participants free of hypertension and CVD at the baseline examination (1989-1992) (N=964) of the Strong Heart Study were selected to explore the cross-sectional association between insulin resistance quantified by homeostasis model assessment (HOMA-IR) and demographic, behavioral, and cardiometabolic variables. The longitudinal association between baseline HOMA-IR and the development of CVD was also explored. The longitudinal association between baseline HOMA-IR and the development of high urinary albumin-to-creatinine ratio was explored among nondiabetic participants (N=1,401). RESULTS Cross-sectionally, HOMA-IR was associated with sex, residence location, smoking, and high-risk cardiometabolic profile. Prospectively, insulin resistance is associated with the development of CVD and decreased kidney function in this population. CONCLUSIONS Insulin resistance may have an important role in the pathogenesis of CVD and chronic kidney disease. Since obesity contributes to the development of insulin resistance, intervention focusing on modifiable factors such as physical activity and weight control may reduce the development of these diseases.
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Kebapci N, Uslu S, Ozcelik E. Metabolic Syndrome Is a Risk Factor for the Development of Chronic Renal Disease. Ren Fail 2013; 35:460-5. [DOI: 10.3109/0886022x.2013.774680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Nam GE, Han K, Park YG, Kim YH, Han B, Kim SM, Choi YS, Cho KH, Lee KS, Kim DH. Prevalence and Related Risk Factors of Albuminuria in Korean Adults: The 2011 Korea National Health and Nutrition Examination Survey. ACTA ACUST UNITED AC 2013; 124:232-8. [DOI: 10.1159/000357950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 12/10/2013] [Indexed: 11/19/2022]
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Lin WY, Pi-Sunyer FX, Liu CS, Li CI, Davidson LE, Li TC, Lin CC. Central obesity and albuminuria: both cross-sectional and longitudinal studies in Chinese. PLoS One 2012; 7:e47960. [PMID: 23251329 PMCID: PMC3520991 DOI: 10.1371/journal.pone.0047960] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 09/19/2012] [Indexed: 11/18/2022] Open
Abstract
Background Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increases the risk of cardiovascular disease. Little is known about the association between albuminuria and central obesity in Chinese. We aimed to assess the association between central obesity and prevalence and incidence of albuminuria in a middle-aged population-based cohort study. Methods This is a cross-sectional and longitudinal cohort study. A total of 2350 subjects aged ≥40 years were recruited in 2004 in Taiwan for cross-sectional analysis. Longitudinal analysis included 1432 baseline normoalbuminuria subjects with a mean 2.8 years follow-up, 67 of whom exhibited incident albuminuria. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g creatinine. Multiple logistic regression analyses were used to evaluate the relationship between central obesity and prevalence and incidence of albuminuria after adjustment for age, gender, body mass index, blood pressure, renal function, glucose, high sensitivity c-reactive protein, smoking, betel nut chewing, alcohol drinking, and physical activity. Results At baseline, albuminuria is significantly associated with central obesity. The adjusted odds ratio of having albuminuria among subjects with central obesity was 1.73(95% confidence interval (CI): 1.04–2.85), compared to the subjects without central obesity. In multivariable models, participants with central obesity at baseline had a 112% increase in risk of incident albuminuria (adjusted incidence rate ratio (95% CI): 2.12(1.01–4.44)) compared with participants with non-central obesity. Conclusions Abdominal adiposity was independently associated with increased prevalence and incidence of albuminuria in Chinese. The mechanisms linking adiposity and albuminuria need to be addressed.
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Affiliation(s)
- Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - F. Xavier Pi-Sunyer
- New York Obesity and Nutrition Research Center, St. Luke's-Roosevelt Hospital, Columbia University–College of Physicians and Surgeons, New York, New York, United States of America
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- Medical Research, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Lance E. Davidson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Tsai-Chung Li
- Medical Research, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
- Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan
- * E-mail:
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Raimundo M, Lopes JA. Metabolic syndrome, chronic kidney disease, and cardiovascular disease: a dynamic and life-threatening triad. Cardiol Res Pract 2011; 2011:747861. [PMID: 21403897 PMCID: PMC3043294 DOI: 10.4061/2011/747861] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/06/2010] [Accepted: 12/24/2010] [Indexed: 01/19/2023] Open
Abstract
The metabolic syndrome (MS) and chronic kidney disease (CKD) have both become global public health problems, with increasing social and economic impact due to their high prevalence and remarkable impact on morbidity and mortality. The causality between MS and CKD, and its clinical implications, still does remain not completely understood. Moreover, prophylactic and therapeutic interventions do need to be properly investigated in this field. Herein, we critically review the existing clinical evidence that associates MS with renal disease and cardiovascular disease, as well as the associated pathophysiologic mechanisms and actual treatment options.
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Affiliation(s)
- Mário Raimundo
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, EPE, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - José António Lopes
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, EPE, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
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Chae SK, Lee JS, Chun JH, Park HS. Metabolic Syndrome and the Risk for Chronic Kidney Disease among Korean Women. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sun Kyung Chae
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jee Soo Lee
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jee Hyun Chun
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Chauveau P, Rigalleau V, Aparicio M. Insulinorésistance et insuffisance rénale chronique. Nephrol Ther 2008; 4:568-74. [DOI: 10.1016/j.nephro.2008.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/09/2008] [Accepted: 03/10/2008] [Indexed: 02/04/2023]
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Chang-Quan H, Bi-Rong D, Ping H, Zhen-Chan L, Xiao-Dong P. Insulin Resistance, Renal Injury, Renal 1-α Hydroxylase, and Bone Homeostasis in Aged Obese Rats. Arch Med Res 2008; 39:380-7. [DOI: 10.1016/j.arcmed.2007.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 12/31/2007] [Indexed: 10/22/2022]
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16
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Lin CY, Chen MF, Lin LY, Liau CS, Lee YT, Su TC. Insulin resistance is the major determinant for microalbuminuria in severe hypertriglyceridemia: implication for high-risk stratification. Intern Med 2008; 47:1091-7. [PMID: 18552465 DOI: 10.2169/internalmedicine.47.0696] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The significance of high triglyceride levels as a risk factor for coronary heart disease is uncertain. We hypothesized that oral glucose tolerance test (OGTT) and certain novel markers may help to identify high-risk patients. PATIENTS AND METHODS We recruited 80 subjects with severe hypertriglyceridemia (age 27-73 years) without clinical proteinuria and diabetes mellitus (DM) which were diagnosed by fasting glucose <126 mg/dL from Hyperlipidemia Clinic of National Taiwan University Hospital for this study. We applied OGTT to evaluate occult DM and homeostasis model assessment (HOMA)-insulin resistance (IR) score to evaluate insulin resistance, and the measurements of microalbuminuria as a marker of vascular damage. In addition, serum or plasma markers of inflammation and fibrinolysis, fasting glucose and insulin as well as traditional cardiovascular risk factors were also evaluated. RESULTS The serum level of triglyceride was higher in patients with microalbuminuria than in those without (14.1+/-5.7 vs. 9.6+/-3.9 mmol/L, p=0.025). Patients with microalbuminuria had higher fasting blood glucose and insulin, higher post-OGTT glucose and insulin, higher prevalence of newly developed diabetes mellitus (DM) (39% vs. 11%, p=0.007) and higher HOMA-IR (6.2+/-4.4 vs. 3.3+/-2.0, p<0.001). Among all the inflammatory and fibrinolytic markers, only soluble intercellular adhesion molecule showed significant different between these two groups. Multiple logistic regression analysis showed that among the serum markers, only HOMA-IR level was significantly related to microalbuminuria. CONCLUSIONS HOMA-IR is the major determinant for microalbuminuria in patients with severe hypertriglyceridemia. Impaired glucose metabolism is evident in patients with both severe hypertriglyceridemia and microalbuminuria.
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Affiliation(s)
- Chien-Yu Lin
- Department of Internal Medicine, En Chu Kong Hospital, Taipei County, Taiwan
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17
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Nguyen S, McCulloch C, Brakeman P, Portale A, Hsu CY. Being overweight modifies the association between cardiovascular risk factors and microalbuminuria in adolescents. Pediatrics 2008; 121:37-45. [PMID: 18166555 PMCID: PMC3722048 DOI: 10.1542/peds.2007-3594] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The goal was to determine the association between cardiovascular risk factors and microalbuminuria in a nationally representative sample of adolescents and to determine whether being overweight modifies this association. METHODS We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (1999-2004) for 2515 adolescents 12 to 19 years of age. Cardiovascular risk factors included abdominal obesity, impaired fasting glucose, diabetes mellitus, insulin resistance, high triglyceride levels, low high-density lipoprotein cholesterol levels, hypertension, smoking, and the metabolic syndrome. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30 to 299 mg/g in a random morning sample. Overweight was defined as BMI of > or = 95th percentile, according to the Centers for Disease Control and Prevention 2000 growth charts. RESULTS Microalbuminuria was present in 8.9% of adolescents. The prevalence of microalbuminuria was higher among nonoverweight adolescents than among overweight adolescents. The median albumin/creatinine ratio decreased with increasing BMI z scores. The association of microalbuminuria with cardiovascular risk factors differed according to BMI category. Among nonoverweight adolescents, microalbuminuria was not associated with any cardiovascular disease risk factor except for overt diabetes mellitus. Among overweight adolescents, however, microalbuminuria was associated with impaired fasting glucose, insulin resistance, hypertension, and smoking, as well as diabetes mellitus. CONCLUSION For the majority of adolescents, microalbuminuria is not associated with cardiovascular risk factors. Among overweight adolescents, however, microalbuminuria is associated with cardiovascular risk factors. The prognostic importance of microalbuminuria in overweight and nonoverweight adolescents with regard to future cardiovascular and renal disease needs to be defined in prospective studies conducted specifically in children.
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Affiliation(s)
- Stephanie Nguyen
- Department of Pediatrics, University of California, San Francisco, California, USA.
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, California
| | - Anthony Portale
- Department of Pediatrics, University of California, San Francisco, California
| | - Chi-yuan Hsu
- Department of Medicine, University of California, San Francisco, California
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Franciosi M, Pellegrini F, Sacco M, De Berardis G, Rossi MCE, Strippoli GFM, Belfiglio M, Tognoni G, Valentini M, Nicolucci A. Identifying patients at risk for microalbuminuria via interaction of the components of the metabolic syndrome: a cross-sectional analytic study. Clin J Am Soc Nephrol 2007; 2:984-91. [PMID: 17702724 DOI: 10.2215/cjn.01190307] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to investigate correlates of risk for having microalbuminuria in individuals with one or more cardiovascular risk factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The study involved 1919 individuals who attended general practice settings, were aged 55 to 75 yr, and did not have a history of cardiovascular events or diabetes but had one or more cardiovascular risk factors. A tree-based regression technique and multivariate analysis were used to identify distinct, homogeneous subgroups of patients with different likelihood of having microalbuminuria; interaction between correlates of microalbuminuria and risk for microalbuminuria was also investigated. RESULTS The prevalence of microalbuminuria was 5.9%. Patients who did not have hypertension and had postload glycemia < 140 mg/dl showed the lowest prevalence of microalbuminuria (1.9%) and represented the reference class. The likelihood of microalbuminuria was seven times higher in men with hypertension and homeostatic model assessment levels in the upper tertile and four times higher in women with the same characteristics. Individuals with hypertension and lower homeostatic model assessment levels and normotensive individuals with postload glycemia > or = 140 mg/dl had a more than three-fold increased likelihood of having microalbuminuria. Treatment with statins was associated with a 54% reduction in the likelihood of having microalbuminuria, whereas levels of triglycerides > 150 mg/dl and fibrinogen levels in the upper tertile were associated with a significantly higher risk for microalbuminuria. CONCLUSIONS The likelihood of having microalbuminuria in a population-based study of elderly individuals is strongly related to the interaction between the components of the metabolic syndrome, particularly hypertension, insulin resistance, and impaired glucose tolerance.
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Affiliation(s)
- Monica Franciosi
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy
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Abstract
Insulin resistance (IR) is associated with multiple risk factors for cardiovascular disease. Many studies have shown that IR is present in chronic renal failure (CRF), and recent evidence suggests that IR can also occur in the early stages of renal disease. Patients with diabetic nephropathy (DN) have an increase in cardiovascular mortality, and since IR may be a contributing factor, this emphasizes the importance of a detailed understanding of the mechanisms linking IR and renal dysfunction at different stages of DN. IR can be detected early on in DN, e.g. at the stage of microalbuminuria (MA) and this could indicate a common genetic trait for IR and DN. As DN progresses further, IR is aggravated and it may, in addition to other factors, possibly accelerate the decline in renal function toward end-stage renal disease (ESRD). Several potentially modifiable mechanisms including circulating hormones, neuroendocrine pathways and chronic inflammation, are said to contribute to the worsening of IR. In ESRD, uremic toxins are of major importance. In this review article, we address the association between different stages of DN and IR and attempt to summarize major findings on potential mechanisms linking DN and IR. We conclude that IR is a consequence, and potentially also a cause of DN. In addition, there are probably genetic and environmental background factors that predispose to both IR and DN.
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Affiliation(s)
- Maria Svensson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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20
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Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 2005; 16:2134-40. [PMID: 15901764 DOI: 10.1681/asn.2005010106] [Citation(s) in RCA: 493] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease; however, no prospective studies have examined the metabolic syndrome as a risk factor for chronic kidney disease (CKD). A total of 10,096 nondiabetic participants who were in the Atherosclerosis Risk in Communities study and had normal baseline kidney function composed the study cohort. The metabolic syndrome was defined according to recent guidelines from the National Cholesterol Education Program. Incident CKD was defined as an estimated GFR (eGFR) <60 ml/min per 1.73 m2 at study year 9 among those with an eGFR > or =60 ml/min per 1.73 m2 at baseline. After 9 yr of follow-up, 691 (7%) participants developed CKD. The multivariable adjusted odds ratio (OR) of developing CKD in participants with the metabolic syndrome was 1.43 (95% confidence interval [CI], 1.18 to 1.73). Compared with participants with no traits of the metabolic syndrome, those with one, two, three, four, or five traits of the metabolic syndrome had OR of CKD of 1.13 (95% CI, 0.89 to 1.45), 1.53 (95% CI, 1.18 to 1.98), 1.75 (95% CI, 1.32 to 2.33), 1.84 (95% CI, 1.27 to 2.67), and 2.45 (95% CI, 1.32 to 4.54), respectively. After adjusting for the subsequent development of diabetes and hypertension during the 9 yr of follow-up, the OR of incident CKD among participants with the metabolic syndrome was 1.24 (95% CI, 1.01 to 1.51). The metabolic syndrome is independently associated with an increased risk for incident CKD in nondiabetic adults.
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Affiliation(s)
- Manjula Kurella
- University of California San Francisco, Department of Nephrology, Laurel Heights, 3333 California Street, Suite 430, San Francisco, CA 94118-1211, USA
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21
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Abstract
Microalbuminuria clusters with the metabolic syndrome, and both conditions predict cardiovascular disease mortality. The reported relationships of microalbuminuria with the individual components of the metabolic syndrome (i.e., hyperglycemia, insulin resistance, hypertension, dyslipidemia, abdominal obesity) are variable. Each of these components, as well as intrauterine effects and diet and other lifestyle factors, may contribute to elevated risk of microalbuminuria in certain population groups. Recent evidence indicates a role for oxidation and inflammation in cardiovascular disease, and endothelial dysfunction (exacerbated by factors such as dyslipidemia) may be the mediator of this relationship. Because endothelial dysfunction can also be manifested as microalbuminuria, this provides a potential explanation of the observed association of the metabolic syndrome, chronic inflammation, and microalbuminuria.
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Affiliation(s)
- Kevin Rowley
- Menzies School of Health Research, P.O. Box 41096, Casuarina, NT 0810, Australia
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22
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Chen J, Muntner P, Hamm LL, Fonseca V, Batuman V, Whelton PK, He J. Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. J Am Soc Nephrol 2003; 14:469-77. [PMID: 12538749 DOI: 10.1097/01.asn.0000046029.53933.09] [Citation(s) in RCA: 254] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study examined the relationship of fasting serum glucose, insulin, C-peptide, glycosylated hemoglobin A (HbA1c), and Homeostasis Model Assessment (HOMA)-insulin resistance to risk of chronic kidney disease (CKD) among 6453 persons without diabetes (fasting glucose <126 mg/dl and not taking diabetes medication) who participated in the Third National Health and Nutrition Examination Survey and were aged 20 yr or older. CKD was defined as an estimated GFR <60 ml/min per 1.73 m(2). The prevalence of CKD was significantly and progressively higher with increasing levels of serum insulin, C-peptide, HbA1c, and HOMA-insulin resistance. After adjustment for potential confounding variables, the odds ratio of CKD for the highest compared with the lowest quartile was 4.03 (95% confidence interval [CI], 1.81 to 8.95; P = 0.001), 11.4 (95% CI, 4.07 to 32.1; P < 0.001), 2.67 (95% CI, 1.31 to 5.46; P = 0.002), and 2.65 (95% CI, 1.25 to 5.62; P = 0.008) for serum insulin, C-peptide, HbA1c levels, and HOMA-insulin resistance, respectively. For a one SD higher level of serum insulin (7.14 micro U/ml), C-peptide (0.45 Deltamol/ml), HbA1c (0.52%), and HOMA-insulin resistance (1.93), the odds ratio (95% CI) of CKD was 1.35 (1.16 to 1.57), 2.78 (2.25 to 3.42), 1.69 (1.28 to 2.23), and 1.30 (1.13 to 1.50), respectively. These findings combined with knowledge from previous studies suggest that the insulin resistance and concomitant hyperinsulinemia are presented in CKD patients without clinical diabetes. Further studies into the causality between insulin resistance and CKD are warranted.
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Affiliation(s)
- Jing Chen
- Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Crook ED, Flack JM, Salem M, Salahudeen AK, Hall J. Primary renal disease as a cardiovascular risk factor. Am J Med Sci 2002; 324:138-45. [PMID: 12240711 DOI: 10.1097/00000441-200209000-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease (CVD) is the No. 1 cause of death in patients with end-stage renal disease (ESRD) and is approximately 3 to 5 times that of non-uremic control subjects. Moreover, higher rates of CVD are seen in patients with moderate and even mild renal dysfunction, particularly if the patient has hypertension or diabetes. Recent studies have indicated that even modest elevations in serum creatinine and urinary albumin excretion are associated with increased CVD risk, not only in persons with diabetes or hypertension but also in the general population. In addition, recent studies have suggested that targeting the kidney and/or kidney specific endpoints (via the renin-angiotensin-aldosterone-kinin system) in the treatment of hypertension, diabetes, and heart failure slows progression of renal disease and reduces the risk of extra-renal micro- and macrovascular complications. We conclude that it is important to screen for renal disease in those with hypertension, diabetes, and other CVD risk factors because it predicts those who are at high risk for major CVD events.
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Affiliation(s)
- Errol D Crook
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA.
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