Clinical Trial Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jul 6, 2015; 4(3): 406-414
Published online Jul 6, 2015. doi: 10.5527/wjn.v4.i3.406
Albuminuria as a marker of arterial stiffness in chronic kidney disease patients
Rigas G Kalaitzidis, Despina P Karasavvidou, Athina Tatsioni, Kosmas Pappas, Giorgos Katatsis, Angelos Liontos, Moses S Elisaf
Rigas G Kalaitzidis, Despina P Karasavvidou, Kosmas Pappas, Giorgos Katatsis, Angelos Liontos, Moses S Elisaf, Outpatient Renal and Hypertension Clinic, University Hospital of Ioannina, 45110 Ioannina, Greece
Athina Tatsioni, Moses S Elisaf, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
Author contributions: Kalaitzidis RG and Elisaf MS designed research; Karasavvidou DP, Pappas K, Katatsis G and Liontos A performed research; Tatsioni A analyzed data; Elisaf MS and Kalaitzidis RG wrote the paper.
Ethics approval statement: Our hospital Ethics Committee approved this study protocol with a registration identification number (AΔΑΒΛΓΦ46906Η-ΛΟΛ).
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Moses Elisaf [melisaf54@gmail.com, egepi@cc.uoi.gr]. Participants gave informed consent for data sharing even though are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moses S Elisaf, MD, FASA, FRSH, Professor, Department of Internal Medicine, Medical School, University of Ioannina, Epirus, 45110 Ioannina, Greece. egepi@cc.uoi.gr
Telephone: +30-265-1007509 Fax: +30-265-1007016
Received: November 4, 2014
Peer-review started: November 9, 2014
First decision: November 27, 2014
Revised: December 22, 2014
Accepted: April 8, 2015
Article in press: April 9, 2015
Published online: July 6, 2015
Processing time: 244 Days and 4 Hours
Abstract

AIM: To access the association between albuminuria levels and arterial stiffness in non-diabetic patients with hypertension and chronic kidney disease (CKD) stages 1-2, treated with renin angiotensin blockade agents plus other hypertensive drugs when needed.

METHODS: One hundred fifteen patients [median age 52 years (68% males)] were consequently enrolled in the study. For each patient, we recorded gender, age, body mass index (BMI), peripheral systolic blood pressure (pSBP), peripheral diastolic blood pressure, peripheral pulse pressure, central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), central pulse pressure (cPP), hematocrit, hemoglobin, hsCRP, total cholesterol triglycerides, high-density lipoprotein-C, low-density lipoprotein-C, calcium, phosphorus, parathormone, and albumin, as well as 24 h urine albumin excretion. According to 24-h urine albumin collection, patients were then classified as those with moderately increased albuminuria (formerly called macroalbuminuria) (≤ 300 mg/d) and those with severely increased albuminuria (formerly called macroaluminuria (> 300 mg/d). We considered aortic stiffness (AS) indices [carotid femoral pulse wave velocity (PWVc-f) and augmentation index (AIx)] as primary outcomes of the study. We explored potential correlations between severely increased albuminuria and AS indices using a multiple linear regression model.

RESULTS: Fifty-eight patients were included in the moderately increased albuminuria group and 57 in the severely increased albuminuria. Blood pressure measurements of the study population were 138 ± 14/82 ± 1.3 mmHg (systolic/diastolic). There were no significant differences in age, sex, and BP measurements between the two groups. Patients with severely increased albuminuria had higher PWV and AIx than patients with moderately increased albuminuria (P < 0.02, P < 0.004, respectively). In addition these patients exhibited higher BMI (P < 0.03), hsCRP (P < 0.001), and fibrinogen levels (P < 0.02) compared to patients with moderately increased albuminuria. In multivariate linear regression analysis, severely increased albuminuria (β = 1.038, P < 0.010) pSBP (β = 0.028, P < 0.034) and Ht (β = 0.171, P = 0.001) remained independent determinants of the increased PWVc-f. Similarly, severely increased albuminuria (β = 4.385, P < 0.012), cSBP (β = 0.242, P < 0.001), cPP (β = 0.147, P < 0.01) and Ht levels (β = 0.591, P < 0.013) remained independent determinants of increased AIx.

CONCLUSION: These findings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic, hypertensive patients with CKD stages 1-2 treated with renin angiotensin aldosterone system blockers.

Keywords: Arterial stiffness; Pulse wave velocity; Augmentation index; Albuminuria

Core tip: Albuminuria heightened cardiovascular disease risk. Pulse wave velocity and augmentation index are markers of aortic stiffness (AS). However, whether severely increased albuminuria is a factor of AS elevation and its progressive deterioration in non-diabetic hypertensive patients treated with renin angiotensin aldosterone blockade agents (RAAS) has not be studied. In this study we aimed to access the association between albuminuria levels and AS, in chronic kidney disease (CKD) stage 1-2 non-diabetic patients with hypertension. All patients were already treated with RAAS blockade agents. Our findings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic, hypertensive patients with CKD stages 1-2 treated with RAAS blockers.