Korean Circ J.  2013 Apr;43(4):255-260. 10.4070/kcj.2013.43.4.255.

Subclinical Renal Insufficiency Range of Estimated Glomerular Filtration Rate and Microalbuminuria Are Independently Associated with Increased Arterial Stiffness in Never Treated Hypertensives

• Nah DY
• Lee CG
• Bae JH
• Chung JW
• Rhee MY
• Kim JH
• Kim YS
• Kim YK
• Lee MM

• KMID: 2224948
• DOI: http://doi.org/10.4070/kcj.2013.43.4.255

Abstract

BACKGROUND AND OBJECTIVES
Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (> or =60 mL/min/1.73 m2) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin.
SUBJECTS AND METHODS
Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, 50.1+/-10.4 years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR > or =90 mL/min/1.73 m2 (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/1.73 m2 (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU.
RESULTS
Group 1 had the lowest hfPWV (964.6+/-145.4; group 2, 1013.5+/-168.9; group 3, 1058.2+/-238.0; group 4, 1065.8+/-162.9 cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048).
CONCLUSION
Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.

Keyword

Glomerular filtration rate; Renal insufficiency; Arterial stiffness

MeSH Terms

Arterial Pressure
Body Mass Index
Cardiovascular Diseases
Diet
Glomerular Filtration Rate
Heart Rate
Humans
Hypertension
Pulse Wave Analysis
Renal Insufficiency
Risk Assessment
Risk Factors
Vascular Stiffness

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