Microalbuminuria is a risk factor for cerebral small vessel disease in community-based elderly subjects

Wada, Manabu; Nagasawa, Hikaru; Kurita, Keiji; Koyama, Shingo; Arawaka, Shigeki; Kawanami, Toru; Tajima, Katsushi; Daimon, Makoto; Kato, Takeshi

doi:10.1016/j.jns.2007.01.066

Cited by 101 publications

(105 citation statements)

References 33 publications

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“…Microalbuminuria is associated with cerebral small vessel disease in community-based elderly subjects (69), and with subclinical atherosclerosis in the Cardiovascular Health Study (70). In the kidney as end-organ, microvascular disease is manifested by nephrosclerosis, secondary leaky glomeruli and proteinuria.…”

Section: The Pathophysiology Of Cognitive Impairment In Hemodialysis mentioning

confidence: 99%

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

346

241

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The heavy burden of cognitive impairment in hemodialysis and chronic kidney disease patients has only recently become recognized. Up to 70 percent of hemodialysis patients ages 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Recent studies describe the strong graded relation between estimated glomerular filtration rate (eGFR) and cognitive function in CKD patients. The process of conventional hemodialysis may induce recurrent episodes of acute cerebral ischemia, which in turn may contribute to acute decline in cognitive function during dialysis. Thus the worst time to communicate with dialysis patients may be during the hemodialysis session. Both symptomatic and occult, subclinical ischemic cerebrovascular disease appear to play a large role in a proposed model of accelerated vascular cognitive impairment in these populations. Severe cognitive impairment or dementia among hemodialysis patients is associated with an approximately two-fold increased risk of both mortality and dialysis withdrawal. Pre-dialysis cognitive screening and adding dementia to the list of comorbidities on Form 2728 would provide critical information regarding the benefit versus risks of receiving dialysis. It could also improve quality of care and outcomes by raising clinician's awareness of the potential effects of cognitive impairment on medication, fluid, and dietary compliance, and ability to make advance directive decisions among dialysis patients. While much remains to be learned regarding the pathophysiology of cognitive impairment in kidney disease, the public health implications of this substantial burden are immediate.

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Section: The Pathophysiology Of Cognitive Impairment In Hemodialysis mentioning

confidence: 99%

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Murray

2008

Advances in Chronic Kidney Disease

346

241

View full text Add to dashboard Cite

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“…8,9 SCI is thought to be a clinical end-organ manifestation of arteriosclerosis in the brain, as well as retinal arterial sclerosis in the eyes and renal sclerosis in the kidneys, 10,11 and the presence of SCI predicts incident clinically evident stroke, 12 cardiovascular disease 13 and dementia. 14 SCI has been also shown to be associated with albuminuria in community-dwelling elderly persons 15 and diabetic patients. 16 We have recently shown that (micro)albuminuria may be a predictor of incident stroke in patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 98%

Silent cerebral infarction is associated with the development and progression of nephropathy in patients with type 2 diabetes

et al. 2010

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Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease in patients with diabetes. The relationship between renal manifestations of CKD (albuminuria and decreased glomerular filtration rate) and silent cerebral infarction (SCI) has attracted attention; however, most studies examined the effects of components of CKD on prevalence of SCI. We sought to assess the relationship between SCI and the development and progression of nephropathy in type 2 diabetic patients. We studied 366 type 2 diabetic patients with normoalbuminuria (urinary albumin-to-creatinine ratio [ACR] o30 mg g -1 , N¼246) or microalbuminuria (ACR¼30-299 mg g -1 , N¼120). SCI was defined by cranial MRI. The primary end point was progression from normo-to microalbuminuria or from micro-to macroalbuminuria. The cumulative incidence of the primary end point was estimated using the Kaplan-Meier method. Risk estimates for reaching the end point were calculated using Cox proportional hazard model analyses. During a median follow-up period of 3.9 years, 23 normoalbuminuric and 24 microalbuminuric patients reached the primary end point. Patients with SCI (N¼171) had a greater incidence of reaching the end point than those without SCI (N¼195, P¼0.020 by the log-rank test), with a hazard ratio of 2.02 (95% confidence interval¼1.09-3.72, P¼0.025) in the multivariate Cox regression model. Although the common pathogenesis of SCI and albuminuria in diabetic patients is still unclear, SCI may be a predictor of progression of nephropathy in type 2 diabetic patients.

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“…[12][13][14] It is regarded not only as a marker of glomerular endothelial damage, but also reflects general endothelial damage [15][16][17][18] and related arterial stiffness. 19 There is a growing body of evidence showing that low-grade albuminuria, well below 3.5 mg mmol À1 , is associated with blood pressure increase, 20,21 endothelial dysfunction, 22,23 arterial stiffness 24 and the development of cardiovascular disease 25 in healthy non-diabetic individuals without chronic kidney disease.…”

Section: Introductionmentioning

confidence: 99%

Arterial stiffness, ambulatory blood pressure and low-grade albuminuria in non-diabetic African and Caucasian men: the SABPA study

Schutte

Huisman

et al. 2011

Hypertens Res

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Recent evidence suggests that low-grade urinary albumin excretion is a marker of early general attenuation of vascular function, but studies are limited to Caucasian population groups. We compared low-grade urinary albumin excretion (o3.5 mg mmol À1 or 30 lg mg À1 ) between non-diabetic African (aged, 41.7 years; n¼70) and Caucasian (aged, 44.6 years; n¼91) men and ethnic-specific associations thereof with arterial stiffness and ambulatory blood pressure. The albumin-to-creatinine ratio (ACR) was determined from an 8 h overnight urine collection. We recorded ambulatory blood pressure over 24 h during a typical workday and the carotid-dorsalis pedis pulse wave velocity measured the next morning after a controlled overnight stay. ACR was higher in Africans compared with Caucasians (Po0.001), also after adjusting for 24 h systolic blood pressure, diastolic blood pressure and hypertension prevalence (Po0.001) or when grouped by similar 24 h mean arterial pressures (Po0.01 for all categories). Daytime (P¼0.002) and night time (Po 0.001) systolic and daytime (Po0.001) and night time (Po0.001) diastolic blood pressures were higher in Africans compared with Caucasians, but no differences existed for daytime and night time pulse pressure and pulse wave velocity. In African men only, after adjustment for covariates, night time systolic blood pressure (b¼0.347; P¼0.003), diastolic blood pressure (b¼0.298; P¼0.010) and mean arterial pressure (b¼0.331; P¼0.004) correlated positively with ACR. In addition, daytime (b¼0.265; P¼0.032) and night time (b¼0.258; P¼0.038) pulse pressure as well as pulse wave velocity (b¼0.271; P¼0.032) correlated positively with ACR. In conclusion, arterial stiffness and ambulatory blood pressure are already associated with low-grade albuminuria in non-diabetic African men with normal kidney function.

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Microalbuminuria is a risk factor for cerebral small vessel disease in community-based elderly subjects

Cited by 101 publications

References 33 publications

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden

Silent cerebral infarction is associated with the development and progression of nephropathy in patients with type 2 diabetes

Arterial stiffness, ambulatory blood pressure and low-grade albuminuria in non-diabetic African and Caucasian men: the SABPA study

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