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de Souza RAF, da Silva EF, de Oliveira DM, Colodette RM, Cotta RMM, da Silva LS, Moreira TR. Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care. BMC Nephrol 2022; 23:257. [PMID: 35858835 PMCID: PMC9301844 DOI: 10.1186/s12882-022-02884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care. STUDY DESIGN The study design used is cross-sectional. METHODS This study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA. RESULTS An increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables. CONCLUSION An association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.
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Affiliation(s)
| | | | | | | | | | | | - Tiago Ricardo Moreira
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil.
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Park S, Woo J, Leem S, Heo NH, Cho NJ, Gil H, Kim JH, Lee EY. Transiently Observed Trace Albuminuria on Urine Dipstick Test Is Associated With All-Cause Death, Cardiovascular Death, and Incident Chronic Kidney Disease: A National Health Insurance Service-National Sample Cohort in Korea. Front Cardiovasc Med 2022; 9:882599. [PMID: 35586653 PMCID: PMC9108188 DOI: 10.3389/fcvm.2022.882599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Albuminuria is a well-known risk factor for end-stage kidney disease, all-cause mortality, and cardiovascular mortality, even when the albumin-to-creatinine ratio is <30 mg/g. However, the association between transiently observed trace albuminuria and these major adverse outcomes has not yet been reported. This study aimed to examine the effect of transient albuminuria on these major adverse outcomes using the National Health Insurance Service data in Korea. Methods and Results The National Health Insurance Service-National Sample Cohort from Korea, followed from 2002 to 2015, consisted of 1,025,340 individuals, accounting for 2.2% of the total Korean population. We analyzed the effect of transient albuminuria on all-cause death, cardiovascular death, and incident chronic kidney disease (CKD) and compared it with the group without albuminuria. Among 1,025,340 individuals, 121,876 and 2,815 had transient albuminuria and no albuminuria, respectively. Adjusted hazard ratios of the transient albuminuria group for cardiovascular death and incident CKD were 1.76 (1.01–3.08) and 1.28 (1.15–1.43), respectively. There were significant differences in all-cause death, cardiovascular death, and incident CKD between the two groups after propensity score matching (p = 0.0037, p = 0.015, and p < 0.0001, respectively). Propensity score matching with bootstrapping showed that the hazard ratios of the transient albuminuria group for all-cause death and cardiovascular death were 1.39 (1.01–1.92) and 2.18 (1.08–5.98), respectively. Conclusions In this nationwide, large-scale, retrospective cohort study, transient albuminuria was associated with all-cause death, cardiovascular death, and incident CKD, suggesting that transient albuminuria could be a risk marker for adverse outcomes in the future, and that its own subclinical phenotype could play an important role during the course of CKD.
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Affiliation(s)
- Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Jiyoung Woo
- Department of Bigdata Engineering, Soonchunhyang University, Asan, South Korea
| | - Subeen Leem
- Department of Bigdata Engineering, Soonchunhyang University, Asan, South Korea
| | - Nam Hun Heo
- Department of Biostatistics, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Nam-Jun Cho
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Hyowook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- BK21 Four Project, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- *Correspondence: Eun Young Lee ;
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Zhang YZ, Huang LN, Shen XM, Lin J, Zhao FY, Yan SJ. Association between sarcopenic overweight and left ventricular diastolic dysfunction and remodeling in patients with type 2 diabetes. Chin Med J (Engl) 2021; 134:2489-2491. [PMID: 34561327 PMCID: PMC8654449 DOI: 10.1097/cm9.0000000000001759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yong-Ze Zhang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Ling-Ning Huang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Xi-Mei Shen
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Jie Lin
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
| | - Feng-Ying Zhao
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Sun-Jie Yan
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
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Wang T, Zhong H, Lian G, Cai X, Gong J, Ye C, Xie L. Low-Grade Albuminuria Is Associated with Left Ventricular Hypertrophy and Diastolic Dysfunction in Patients with Hypertension. Kidney Blood Press Res 2019; 44:590-603. [PMID: 31387099 DOI: 10.1159/000500782] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/22/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Microalbuminuria is a risk factor for cardiovascular morbidity and mortality in hypertensive patients. However, the relationship between low-grade albuminuria, a higher level of albuminuria below microalbuminuria threshold, and hypertension-related organ damage is unclear. Left ventricular (LV) hypertrophy (LVH) is well recognized to be a subclinical organ damage of hypertension, and LV diastolic dysfunction is also reported to be an early functional cardiac change of hypertension that predicts heart failure. The present study aimed to investigate the association of low-grade albuminuria with LVH and LV diastolic dysfunction in hypertensive patients. METHODS This cross-sectional observational clinical study was retrospectively performed in 870 hypertensive patients admitted to our hospital. Urinary albumin to creatinine ratio (UACR) was calculated to assess the levels of albuminuria: macroalbuminuria (≥300 mg/g), microalbuminuria (≥30 mg/g, but <300 mg/g), and normal albuminuria (<30 mg/g). Low-grade albuminuria was defined as sex-specific highest tertile within normal albuminuria (8.1-29.6 mg/g in males and 11.8-28.9 mg/g in females). LVH and LV diastolic dysfunction were identified as recommended by American Society of Echocardiography. RESULTS Of the 870 patients, 765 (87.9%) had normal albuminuria, 77 (8.9%) had microalbuminuria, and 28 (3.2%) had macroalbuminuria. Percentage of LVH and LV diastolic dysfunction was increased with ascending UACR. UACR was independently associated with LVH and LV diastolic dysfunction, even in patients with normal albuminuria. Multivariable logistic regression showed that the patients with the highest tertile within normal albuminuria had nearly 80% increase in LVH and nearly 60% increase in LV diastolic dysfunction (adjusted OR for LVH 1.788, 95% CI 1.181-2.708, p = 0.006; adjusted OR for LV diastolic dysfunction 1.567, 95% CI 1.036-2.397, p = 0.034). After further stratification analyses in patients with normal albuminuria, it was shown that this independent association persisted in female patients, those who were younger than 70 years old, and those with duration of hypertension <15 years. CONCLUSION Low-grade albuminuria was associated with LVH and LV diastolic dysfunction in hypertensive patients, especially in patients younger than 70 years old, and those with duration of hypertension <15 years.
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Affiliation(s)
- Tingjun Wang
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hongbin Zhong
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guili Lian
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaoqi Cai
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin Gong
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chaoyi Ye
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liangdi Xie
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China,
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Kang SH, Park JW, Cho KH, Do JY. Association Between Periodontitis and Low-Grade Albuminuria in Non-Diabetic Adults. Kidney Blood Press Res 2017; 42:338-346. [PMID: 28578341 DOI: 10.1159/000477784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/21/2017] [Indexed: 11/19/2022] Open
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Kang SH, Park JW, Do JY, Cho KH. Glycated hemoglobin A1c level is associated with high urinary albumin/creatinine ratio in non-diabetic adult population. Ann Med 2016; 48:477-484. [PMID: 27320476 DOI: 10.1080/07853890.2016.1197412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Regarding the association between glycated hemoglobin A1c (HbA1c) levels and microvascular complications, high HbA1c level in participants without diabetes mellitus (DM) may be associated with a high urinary albumin-to-creatinine ratio (UACR). PATIENTS AND METHODS Twelve thousand seven hundred and seventy four participants without DM were included in this study. The participants were divided into three groups according to HbA1c levels: a Low group (<5.7%), Middle group (5.7-6.0%), and High group (>6.0%). A high UACR was defined as UACR ≥3.9 mg/g for men and UACR ≥7.5 mg/g for women. RESULTS The proportions of participants with a high UACR in the Low, Middle, and High groups were 22.4%, 27.9%, and 38.1%, respectively. Both univariate and multivariate analyses showed that logUACR was greatest in the High group compared to the other groups. For participants without metabolic syndrome (MetS), the proportions of participants with high UACR and logUACR values were greatest in the High group compared to the other groups. For participants with MetS, no differences were found for proportions of participants with high UACR and logUACR values in the Low, Middle, and High groups. CONCLUSION Non-DM participants with relatively high HbA1c levels should be closely monitored for UACR, especially if participants do not have MetS. KEY MESSAGES HbA1c level was positively associated with the proportion of participants with a high UACR and logUACR in participants without DM. For participants without MetS, the proportion of participants with a high UACR was greater in the High group than in the other groups and logUACR was greatest in the High group compared to the other groups. For participants with MetS, there were significant associations between HbA1c and the proportion of participants with a high UACR as a categorical variable or logUACR as a continuous variable, but the statistical significance of this finding was weak. No differences were found for proportions of participants with high UACR and logUACR values in the Low, Middle, and High groups.
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Affiliation(s)
- Seok Hui Kang
- a Division of Nephrology, Department of Internal Medicine , Yeungnam University Hospital , Daegu , Republic of Korea
| | - Jong Won Park
- a Division of Nephrology, Department of Internal Medicine , Yeungnam University Hospital , Daegu , Republic of Korea
| | - Jun Young Do
- a Division of Nephrology, Department of Internal Medicine , Yeungnam University Hospital , Daegu , Republic of Korea
| | - Kyu Hyang Cho
- a Division of Nephrology, Department of Internal Medicine , Yeungnam University Hospital , Daegu , Republic of Korea
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