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Affiliation(s)
- James Heaf
- Department of Nephrology Copenhagen University Hospital Herlev, Denmark
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Martens RJH, Henry RMA, Houben AJHM, van der Kallen CJH, Kroon AA, Schalkwijk CG, Schram MT, Sep SJS, Schaper NC, Dagnelie PC, Muris DMJ, Gronenschild EHBM, van der Sande FM, Leunissen KML, Kooman JP, Stehouwer CDA. Capillary Rarefaction Associates with Albuminuria: The Maastricht Study. J Am Soc Nephrol 2016; 27:3748-3757. [PMID: 27160406 DOI: 10.1681/asn.2015111219] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/07/2016] [Indexed: 11/03/2022] Open
Abstract
Albuminuria may be a biomarker of generalized (i.e., microvascular and macrovascular) endothelial dysfunction. According to this concept, endothelial dysfunction of the renal microcirculation causes albuminuria by increasing glomerular capillary wall permeability and intraglomerular pressure, the latter eventually leading to glomerular capillary dropout (rarefaction) and further increases in intraglomerular pressure. However, direct evidence for an association between capillary rarefaction and albuminuria is lacking. Therefore, we examined the cross-sectional association between the recruitment of capillaries after arterial occlusion (capillary density during postocclusive peak reactive hyperemia) and during venous occlusion (venous congestion), as assessed with skin capillaroscopy, and albuminuria in 741 participants of the Maastricht Study, including 211 participants with type 2 diabetes. Overall, 57 participants had albuminuria, which was defined as a urinary albumin excretion ≥30 mg/24 h. After adjustment for potential confounders, participants in the lowest tertile of skin capillary recruitment during postocclusive peak reactive hyperemia had an odds ratio for albuminuria of 2.27 (95% confidence interval, 1.07 to 4.80) compared with those in the highest tertile. Similarly, a comparison between the lowest and the highest tertiles of capillary recruitment during venous congestion yielded an odds ratio of 2.89 (95% confidence interval, 1.27 to 6.61) for participants in the lowest tertile. In conclusion, lower capillary density of the skin microcirculation independently associated with albuminuria, providing direct support for a role of capillary rarefaction in the pathogenesis of albuminuria.
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Affiliation(s)
- Remy J H Martens
- Department of Internal Medicine, Division of Nephrology and.,School of Nutrition and Translational Research in Metabolism
| | - Ronald M A Henry
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Alfons J H M Houben
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | | | - Abraham A Kroon
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Casper G Schalkwijk
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Miranda T Schram
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Simone J S Sep
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Nicolaas C Schaper
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht.,School for Public Health and Primary Care
| | - Pieter C Dagnelie
- Cardiovascular Research Institute Maastricht.,School for Public Health and Primary Care.,Department of Epidemiology, and
| | - Dennis M J Muris
- Departments of Internal Medicine and.,Cardiovascular Research Institute Maastricht
| | - Ed H B M Gronenschild
- Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands; and.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Karel M L Leunissen
- Department of Internal Medicine, Division of Nephrology and.,School of Nutrition and Translational Research in Metabolism
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology and.,School of Nutrition and Translational Research in Metabolism
| | - Coen D A Stehouwer
- Departments of Internal Medicine and .,Cardiovascular Research Institute Maastricht
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part II: role of cigarette smoking in cardiovascular disease development. Biomark Med 2010; 3:617-53. [PMID: 20477529 DOI: 10.2217/bmm.09.51] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Potential mechanisms and biomarkers of atherosclerosis related to cigarette smoking - a modifiable risk factor for that disease - are discussed in this article. These include smoking-associated inflammatory markers, such as leukocytes, high-sensitivity C-reactive protein, serum amyloid A, ICAM-1 and IL-6. Other reviewed markers are indicative for smoking-related impairment of arterial endothelial function (transcapillary leakage of albumin, inhibition of endogenous nitric oxide synthase activity and reduced endothelium-dependent vasodilation) or point to oxidative stress caused by various chemicals (cholesterol oxidation, autoantibodies to oxidized low-density lipoprotein, plasma levels of malondialdehyde and F(2)-isoprostanes and reduced antioxidant capacity). Smoking enhances platelet aggregability, increases blood viscosity and shifts the pro- and antithrombotic balance towards increased coagulability (e.g., fibrinogen, von Willebrand factor, ICAM-1 and P-selectin). Insulin resistance is higher in smokers compared with nonsmokers, and hemoglobin A1c is dose-dependently elevated, as is homocysteine. Smoke exposure may influence the kinetics of markers with different response to transient or chronic changes in cigarette smoking behavior.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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Feldman JG, Gange SJ, Bacchetti P, Cohen M, Young M, Squires KE, Williams C, Goldwasser P, Anastos K. Serum albumin is a powerful predictor of survival among HIV-1-infected women. J Acquir Immune Defic Syndr 2003; 33:66-73. [PMID: 12792357 DOI: 10.1097/00126334-200305010-00010] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We previously reported that single measurements of albumin strongly predict survival in HIV-1-infected women independent of disease-specific markers. We now extend this to the use of serial measurements and single albumin values prior to initiation of highly active antiretroviral therapy. DESIGN Prospective cohort study of 1941 women enrolled at six sites in the Women's Interagency HIV Study. RESULTS Albumin fell 0.44 g/L/y in 1627 women who survived and at a faster rate in 397 who died (1.54 g/L/y; p <.01). In a time-dependent model adjusting for disease markers, the relative hazard (RH) was fivefold higher in patients with serum albumin <35 g/L compared with patients with serum albumin >42 g/L. The RH of serum albumin <35 g/L in women with CD4+ lymphocyte counts > or =200 cells/micro L was 8.2 [95% CI: 4.2-15.8]) versus only 3.8 [95% CI: 2.4-6.1] in those with counts <200 cells/mm3. In a fixed-covariate Cox analysis of patients who started HAART during the study, albumin prior to HAART was associated with a higher RH (7.0 for albumin <35 g/L versus >42 g/L) than were other factors. CONCLUSION Serum albumin is a strong independent predictor of mortality in HIV-1-infected women after adjustment for known disease markers and may be useful for clinical monitoring.
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Affiliation(s)
- Joseph G Feldman
- State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
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Abstract
Reduced levels of serum albumin concentration, a routine blood test, within the "normal" range have been reported to be associated with mortality risk. The literature is reviewed, with a focus on cohort studies meeting specified criteria, and findings are summarized. In studies of many populations, comprising healthy subjects and patients with acute or chronic illness, serum albumin concentration is inversely related to mortality risk in a graded manner over its entire range; the estimated increase in the odds of death ranges from 24% to 56% for each 2.5 g/l decrement in serum albumin concentration. The association predicts overall and cause-specific mortality including cardiovascular mortality. It is likely that albumin concentration is a highly sensitive indicator of preclinical disease and disease severity. A direct protective effect of the albumin molecule is suggested by the persistence of the association after adjustment for other known risk factors and preexisting illness, and after exclusion of early mortality. Although biologically plausible, there is no direct evidence for this hypothesis. Serum albumin concentration is an independent predictor of mortality risk and could be useful in the quantification of risk in a broad range of clinical and research settings.
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Affiliation(s)
- P Goldwasser
- Department of Medicine, Brooklyn Veterans Affairs Medical Center, New York 11209, USA
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