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MedWire News: Measuring both urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) could improve assessment of patients' cardiovascular (CV) risk related to kidney dysfunction, research suggests.
Both UAE and eGFR are related to CV disease, based on longitudinal, population-based studies. Massimo Cirillo (Second University of Naples, Italy) and team looked at whether the two markers might provide complementary or overlapping information for CV risk assessment.
The researchers analyzed UAE, eGFR, CV risk factors, and incidence of CV disease in 1665 men and women living in Gubbio, a city in central Italy.
Participants were aged 45 to 64 years at baseline and the average follow-up period was 10.4 years, during which time there were 110 CV disease events. High UAE was defined as the highest decile of UAE levels in the population, the cut-off being 18.61 µg/min or higher in men and 15.77 µg/min or higher in women.
Meanwhile, the cut-off for low eGFR, defined as the lowest decile, was less than 64.20 ml/min/1.73 m2 in men and less than 57.90 ml/min/1.73 m2 in women.
Using both markers to give composite kidney dysfunction, fewer individuals were defined as having no dysfunction (n=1354), and 1.86 times more as having dysfunction (n=311), compared with using either marker alone (n=1498 and 167, respectively, for both markers). This reflected that UAE and eGFR clustered in different individuals and were weakly associated with each other, the others note
Hazard ratios for incident CV disease events were elevated for both high UAE and low eGFR independently of each other, at 2.15 and 2.10, respectively. When kidney dysfunction was defined using both markers, the HR for CV events was 2.09 compared with no kidney dysfunction.
Kidney dysfunction defined by both markers predicted CV disease independently of established CV risk factors, at a HR of 1.50.
Using receiver operating characteristic curve analysis, dysfunction defined by both markers predicted CV disease accurately and slightly more so than diabetes, prior CV disease, left ventricular hypertrophy, or obesity.
"High UAE and low eGFR provide complementary information in defining kidney dysfunction because they cluster in different individuals," the team concludes in the Archives of Internal Medicine.
