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High-normal albuminuria is associated with subclinical atherosclerosis in male population with estimated glomerular filtration rate ?60 mL/min/1.73 m2: A cross-sectional study

木村友恵広島大学

2020.02.27

概要

Atherosclerosis is a state whereby the inside of an artery hardens and narrows [1]. Even without
symptoms in the early phase, atherosclerosis eventually causes severe cardiovascular disease
(CVD) such as coronary heart disease and stroke. Currently the impact of atherosclerosis is estimated at 422.7 million CVD events and 17.9 million CVD deaths worldwide [2], confirming its
consideration as a major health problem. According to previous studies, carotid atherosclerosis
correlates with not only coronary and cerebral atherosclerosis, but also incidence of CVD [3, 4].
Subsequently, carotid intima-media thickness (IMT) and the extent of atheromatous carotid
plaque measured by ultrasonography have become well-established methods for the evaluation
of atherosclerosis [5]. In the clinical setting, carotid duplex is mainly performed in subjects with
a risk factor for CVD, including smoking, obesity, hypertension, diabetes, and dyslipidemia [6].
Nonetheless many people still die of CVD; therefore, unconventional risk factors should also be
determined for the early evaluation of atherosclerosis.
Chronic kidney disease (CKD) has been well recognized as a risk factor for CVD alongside
conventional risk factors. In addition to decline in estimated glomerular filtration rate (eGFR)
to below 60 mL/min/1.73 m2, urinary albumin excretion has also been reported as a strong
and independent predictor of CVD mortality [7, 8]. Clinically, the urinary albumin-to-creatinine ratio (UACR) of a spot urine sample has been used to evaluate the daily urinary albumin
excretion, and UACR <30 mg/g has been defined as normal. Although normal albuminuria in
a population with eGFR �60 mL/min/1.73 m2 is classified in a low-risk group in the Kidney
Disease Improving Global Outcomes heat map [9], recent reports have revealed that, even
within normal levels of albuminuria, high-normal albuminuria has emerged as a risk factor for
the onset of CVD [8–10]. Additionally, a recent meta-analysis has reported that the cut-off
value of UACR that predicts CVD mortality is more than 10 mg/g [8, 9]. In terms of association between UACR and atherosclerosis, previous studies have demonstrated that high-normal
albuminuria correlates with IMT [11]. However, the effect of high-normal albuminuria on
subclinical atherosclerosis in individuals with eGFR �60 mL/min/1.73 m2 remains unknown.
These findings led us to the idea that determining the association between high-normal albuminuria and carotid atherosclerosis in a healthy population can help prevent a CVD event.
We conducted a cross-sectional study to investigate the associations between the normal
range of UACR and subclinical atherosclerosis in Japanese non-diabetic men with eGFR �60
mL/min/1.73 m2 by performing ultrasonographic assessment of carotid IMT and plaque number. We also compared the thickness of IMT and proportion of plaque number between the
populations with low- and high-normal UACR. Moreover, we employed a multivariate regression model to examine whether high-normal albuminuria predicts IMT and plaque number. ...

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High-normal albuminuria is associated with subclinical atherosclerosis in male population with estimated glomerular filtration rate ?60 mL/min/1.73 m2: A cross-sectional study

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