[Home] [Headlines] [Latest Articles] [Latest Comments] [Post] [Sign-in] [Mail] [Setup] [Help]
Status: Not Logged In; Sign In
|
Health See other Health Articles Title: Kidney health predicts heart health Medscape...Estimated glomerular filtration rate and albuminuria independently predict cardiovascular mortality and heart failure, according to a meta-analysis of individual data from more than 600,000 study participants published online May 28 in the Lancet Diabetes and Endocrinology. Lead author Kunihiro Matsushita, MD, PhD, from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told Medscape Medical News, "I hope our results will encourage physicians to assess both kidney function and damage among those with diabetes, hypertension and kidney disease, and consider the information on kidney disease to classify cardiovascular risk of the patient." Importantly, physicians may already have the numbers they need for assessment. The most common test for kidney function is estimated glomerular filtration rate (eGFR), which checks how well kidneys are filtering blood. That test is given approximately 290 million times a year in the United States, the authors note. Another test is the albumin-to-creatinine ratio (ACR), which measures protein in the urine to check for kidney damage. The test is commonly given, especially to those with diabetes, hypertension, and kidney disease. "Our data demonstrated that the use of that kind of information can help physicians predict future cardiovascular risk better than when they use traditional risk factors," Dr Matsushita said. The researchers analyzed data from 637,315 participants with no history of cardiovascular disease in the Chronic Kidney Disease Prognosis Consortium. The investigators found that both eGFR levels and albuminuria independently predicted cardiovascular disease, particularly heart failure and death from heart attack and stroke. ACR was the stronger predictor — stronger than cholesterol or systolic blood pressure, or even whether someone was a smoker — in predicting heart failure or death from heart attack or stroke. The data support guidelines that call for the kidney tests among those with diabetes, hypertension, and chronic kidney disease, but Dr Matsushita suggests the data may also support wider use. For instance, ACR was a more effective predictor among blacks than among whites, he said. Determining how widely the tests should be administered would take further study and cost analysis, he added. Measures Not Meant to Replace Tests "Our intention is not to eliminate existing tests," he said, but on top of those tests, "kidney measures can contribute to better prediction." Dr Matsushita said using both eGFR and ACR in combination was a better predictor of cardiovascular disease than almost all traditional risk factors among people with chronic kidney disease. The C statistic for cardiovascular mortality dropped by 0.0227 (95% confidence interval, 0.0158 - 0.0296) after omission of eGFR and ACR compared with less than 0.007 for any single modifiable traditional predictor. The information is especially important because people with chronic kidney disease are twice as likely as those with healthy kidneys to develop cardiovascular disease, and about half of them die from cardiovascular disease before they reach kidney failure. Improvement of cardiovascular prediction was more evident among those with diabetes, he said. Study results add support to use of existing clinical guidelines, which include assessment for kidney disease. In an accompanying comment, Alberto Ortiz, MD, PhD, and Beatriz Fernandez-Fernandez, MD, from the Nephrology and Hypertension Department at the Universidad Autonoma de Madrid in Spain, say the study settles the question of whether the tests are a good predictors of cardiovascular disease, but raises other questions. Among them are, "Could pathological urinary ACR cause the increased risk, and if so, how? Could albuminuria promote kidney inflammation and decrease klotho expression, leading to resistance to the phosphaturic effect of fibroblast growth factor-23? Would albuminuria, inflammation, or phosphate thus be potential therapeutic targets?" They say, however, that given the results, authors of clinical guidelines, especially those focused on preventing cardiovascular deaths, should consider incorporating urinary ACR into algorithms for estimating cardiovascular risk. Robert Albright, DO, associate professor of medicine and chairman of the Division of Nephrology and Hypertension at the Mayo Clinic, Rochester, Minnesota, said this study may be one more bit of data that could encourage policy writers to address screening for chronic kidney disease in the general population. He noted that the American College of Physicians recommends against routine screening for albuminuria in patients without diabetes. "They didn't feel the literature supported it," he told Medscape Medical News. "I think this study may ask the powers that be to readdress whether these screening tests should be part of a population health strategy." Post Comment Private Reply Ignore Thread
|
||
|
[Home]
[Headlines]
[Latest Articles]
[Latest Comments]
[Post]
[Sign-in]
[Mail]
[Setup]
[Help]
|
||