Microalbuminuria as an Integrated Biomarker for Cardiovascular Risk Stratification and Early Renal Dysfunction in Patients with Essential Hypertension
Microalbuminuria in Hypertension: A Biomarker for Cardiovascular and Renal Risk
DOI:
https://doi.org/10.69750/dmls.01.07.064Keywords:
Microalbuminuria, Hypertension, Cardiovascular Risk, Renal Impairment, BiomarkersAbstract
Background: Microalbuminuria, defined as the excretion of 30–300 mg of albumin in the urine per day, is an early marker of renal impairment and cardiovascular complications. In essential hypertension, it may signify heightened end-organ damage.
Objectives: To determine the prevalence of microalbuminuria in hypertensive patients and evaluate its utility as a biomarker for early renal impairment and cardiovascular risk stratification.
Methods: This study, conducted at Nishtar-II Tertiary Care Hospital, Multan, from February to September 2024, included 200 hypertensive patients aged 20–60 years. Spot urine samples assessed microalbuminuria, while cardiovascular risk was evaluated using the Framingham Risk Score. Renal function was assessed via blood creatinine, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR). Statistical analysis, including multivariate regression, identified predictors and correlations.
Results: Microalbuminuria prevalence was 38%. Patients with microalbuminuria had significantly higher BMI, systolic/diastolic blood pressure, and ACR (p < 0.05). Independent predictors included BMI (OR = 1.25), systolic BP (OR = 1.15), blood creatinine (OR = 1.52), and ACR (OR = 1.02). A strong inverse correlation between eGFR and microalbuminuria (r = -0.45, p < 0.001) highlighted early renal impairment.
Conclusion: Microalbuminuria serves as a significant biomarker for cardiovascular and renal risk in hypertension. Routine screening can identify high-risk individuals early, enabling timely interventions to prevent disease progression.
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Provenzano M, Andreucci M, De Nicola L, Garofalo C, Battaglia Y, Borrelli S, et al. The Role of Prognostic and Predictive Biomarkers for Assessing Cardiovascular Risk in Chronic Kidney Disease Patients. BioMed Research International. 2020;2020(1):2314128.doi:10.1155/2020/2314128
Hong Z, Jiang Y, Liu P, Zhang L. Association of microalbuminuria and adverse outcomes in hypertensive patients: a meta-analysis. International Urology and Nephrology. 2021; 53(11):2311-9.doi:10.1007/s11255-021-02795-w
Pafundi PC, Garofalo C, Galiero R, Borrelli S, Caturano A, Rinaldi L, et al. Role of Albuminuria in Detecting Cardio-Renal Risk and Outcome in Diabetic Subjects. Diagnostics [Internet]. 2021; 11(2).doi: 10.3390/diagnostics11020290
Márquez DF, Rodríguez-Sánchez E, de la Morena JS, Ruilope LM, Ruiz-Hurtado G. Hypertension mediated kidney and cardiovascular damage and risk stratification: Redefining concepts. Nefrología.2022;42(5):519-30.doi:10.1016/ j.nefro.2021.10.003
Bessa J, Albino-Teixeira A, Reina-Couto M, Sousa T. Endocan: A novel biomarker for risk stratification, prognosis and therapeutic monitoring in human cardiovascular and renal diseases. Clinica Chimica Acta. 2020;509:310-35.doi:10.1016/j.cca.2020.07.041
Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. Journal of the American Heart Association. 2024; 13(2):e030131.doi:10.1161/JAHA.123.030131
de Souza RAF, da Silva EF, de Oliveira DM, Colodette RM, Cotta RMM, da Silva LS, et al. Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care. BMC Nephrology. 2022;23(1):257.doi: 10.1186/s1288 2-022-02884-7
Ruilope LM, Ortiz A, Lucia A, Miranda B, Alvarez-Llamas G, Barderas MG, et al. Prevention of cardiorenal damage: importance of albuminuria. European Heart Journal. 2023; 44(13):1112-23.doi: 10.1093/eurheartj/ehac683
Wang MC, Lloyd-Jones DM. Cardiovascular Risk Assessment in Hypertensive Patients. American Journal of Hypertension. 2021;34(6):569-77.doi: 10.1093/ajh/hpab021
Szabóová E, Lisovszki A, Fatľová E, Kolarčik P, Szabó P, Molnár T. Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension. Diagnostics [Internet]. 2021; 11(9).doi: 10.3390/diagnostics11091716
Wada H, Shinozaki T, Suzuki M, Sakagami S, Ajiro Y, Funada J, et al. Impact of Chronic Kidney Disease on the Associations of Cardiovascular Biomarkers With Adverse Outcomes in Patients With Suspected or Known Coronary Artery Disease: The EXCEED‐J Study. Journal of the American Heart Association. 2022;11(3): e023464.doi: 10.1161/JAHA.121.023464
Nowak C, Ärnlöv J. Kidney Disease Biomarkers Improve Heart Failure Risk Prediction in the General Population. Circulation: Heart Failure. 2020;13(8):e006904.doi: 10.1161/CIRCHEARTFAILURE.120.006904
Vicente-Vicente L, Casanova AG, Hernández-Sánchez MT, Prieto M, Martínez-Salgado C, López-Hernández FJ, et al. Albuminuria Pre-Emptively Identifies Cardiac Patients at Risk of Contrast-Induced Nephropathy. Journal of Clinical Medicine [Internet]. 2021; 10(21).doi: 10.3390/jcm10214942
Degenaar A, Jacobs A, Kruger R, Delles C, Mischak H, Mels CMC. Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study. BMC Nephrology. 2023;24(1):96.doi: 10.1186/s12882-023-03100-w
Oleksandr MB, Iryna IK, Oleksandr MK, Vladyslav IK, Denis AK, Lilya PA, et al. Early diagnosis of renal dysfunction in hypertensive patients with type 2 diabetes mellitus. Journal of Biochemical Technology. 2020;11(4):102-9.doi: 10.51847/J2_3L-B
Böhm M, Schumacher H, Teo KK, Lonn EM, Mahfoud F, Emrich I, et al. Renal outcomes and blood pressure patterns in diabetic and nondiabetic individuals at high cardiovascular risk. Journal of Hypertension. 2021;39(4):766-74.doi: 10.1097/hjh.0000000000002697
Raja P, Maxwell AP, Brazil DP. The Potential of Albuminuria as a Biomarker of Diabetic Complications. Cardiovascular Drugs and Therapy. 2021;35(3):455-66.doi: 10.1007/s10557-020-07035-4
Khan MB, Scherzer R, Lewis CE, Malhotra R, Ix JH, Shlipak MG, et al. Associations of Urine Biomarkers of Kidney Tubule Health With Incident Hypertension and Longitudinal Blood Pressure Change in Middle-Aged Adults: The CARDIA Study. Hypertension. 2023;80(6):1353-62.doi: 10.1161/HYPERTENSIONAHA.123.21084
Stopic B, Medic-Brkic B, Savic-Vujovic K, Davidovic Z, Todorovic J, Dimkovic N. Biomarkers and Predictors of Adverse Cardiovascular Events in Different Stages of Chronic Kidney Disease. Dose-Response. 2022;20(3).doi: 10.1177/15593258221127568
Di Marco M, Scilletta S, Miano N, Marrano N, Natalicchio A, Giorgino F, et al. Cardiovascular risk and renal injury profile in subjects with type 2 diabetes and non-albuminuric diabetic kidney disease. Cardiovascular Diabetology. 2023;22(1): 344.doi: 10.1186/s12933-023-02065-2
Bielopolski D, Rahamimov R, Zingerman B, Chagnac A, Azulay-Gitter L, Rozen Zvi B. Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity. Frontiers in Medicine. 2021;8.doi: 10.3389/fmed.2021.63584 7
Ceccarelli Ceccarelli D, Paleari R, Solerte B, Mosca A. Re-thinking diabetic nephropathy:
Microalbuminuria is just a piece of the diagnostic puzzle. Clinica Chimica Acta. 2022;524:146-53.doi:10.1016/j.cca.2021.11.009
Kourtidou C, Stangou M, Marinaki S, Tziomalos K. Novel Cardiovascular Risk Factors in Patients with Diabetic Kidney Disease. International Journal of Molecular Sciences [Internet]. 2021; 22(20).doi: 10.3390/ijms222011196
Piko N, Bevc S, Ekart R, Petreski T, Vodošek Hojs N, Hojs R. Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk. World J Diabetes. 2021;12(7): 975-96.doi: 10.4239/wjd.v12.i7.975
Swaminathan SM, Rao IR, Shenoy SV, Prabhu AR, Mohan PB, Rangaswamy D, et al. Novel biomarkers for prognosticating diabetic kidney disease progression. International Urology and Nephrology. 2023;55(4):913-28.doi: 10.1007/s11 255-022-03354-7
Theuerle JD, Al-Fiadh AH, Wong E, Patel SK, Ashraf G, Nguyen T, et al. Retinal microvascular function predicts chronic kidney disease in patients with cardiovascular risk factors. Atherosclerosis. 2022;341:63-70.doi: 10.1016/j. atherosclerosis.2021.10.008
Shin J-I, Chang AR, Grams ME, Coresh J, Ballew SH, Surapaneni A, et al. Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium. Hypertension. 2021;78(4):1042-52.doi:10.1161/HYPERTENSIONAHA.121.17323
Khan SS, Coresh J, Pencina MJ, Ndumele CE, Rangaswami J, Chow SL, et al. Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2023;148(24):1982-2004.doi: 10.1161/CIR.0000000000001191
Provenzano M, Rotundo S, Chiodini P, Gagliardi I, Michael A, Angotti E, et al. Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease. International Journal of Molecular Sciences [Internet]. 2020; 21(16).doi: 10.3390/ijms2116 5846
Lin G-M, Canoy D. Editorial: Renal function and related biomarkers in cardiovascular risk assessment and prevention. Frontiers in Cardiovascular Medicine. 2022;9.doi: 10.3389/ fcvm.2022.1069629
Brobak KM, Halvorsen LV, Aass HCD, Søraas CL, Aune A, Olsen E, et al. Novel biomarkers in patients with uncontrolled hypertension with and without kidney damage. Blood Pressure. 2024;33(1):2323980.doi:10.1080/08037051.2024.2323980
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