- Although microalbuminuria is generally identified as an early maker of kidney disease it has now been firmly established as a potent predictor for the development of severe CAD (coronary artery disease) as well as a prognostic marker in people with pre-existing CAD. People with microalbuminuria usually have greater burden of atherosclerosis.
- Microalbuminuria is also an independent predictor of cardiovascular (CVD) and all-cause mortality in people with and without diabetes or hypertension.1 As a result, patients with microalbuminuria need to be treated more aggressively especially in the presence of CAD.
- Microalbuminuria is a common accompaniment of metabolic syndrome, chronic kidney disease, and CAD. Recent research indicates that the three conditions appear to be intertwined. 2, 3 4
- Overconsumption of calories and/or their underutilization is resulting in an explosion of metabolic syndrome world-wide. Because of its high prevalence, some experts have even recommended including microalbuminuria as one of the components of metabolic syndrome.5 Intensive exercise and weight loss in individuals with metabolic syndrome result in improvement of kidney function.6
- Hypertension and diabetes are associated with a 2 to 3-fold increase in microalbuminuria and it may be an early marker of renal disease in people with these conditions.7-9 Treatment of hypertension and diabetes particularly with angiotensin converting enzyme inhibitors (ACEI) and AT1-receptor blockers (ARBS) improve insulin sensitivity and ameliorate microalbuminuria in addition to their well documented cardiac and renal protective effects.10
- Dyslipidemia, particularly high triglyceride and low HDL, are highly correlated with microalbuminuria and chronic kidney disease and treatment of dyslipidemia may reduce the progression of kidney disease.11-13
- Statin use may retard the progression of renal dysfunction, which appears to be independent of their lipid-lowering effect.14
- Metformin is contraindicate in patients with impaired renal function, but has shown to be effective in preventing the development of diabetes in pre-diabetic individuals.15
- Clinical trials are clearly documented that changes in albuminuria over time with treatment translate to changes in cardiovascular risk. As a result, monitoring of albuminuria should be an integrated part of the management of hypertension and diabetes. If albuminuria is not decreased by the patient’s current treatment, further intervention with ACE-inhibitors or ARBS should be undertaken along with control and other modifiable risks factors.4, 16
- Ramipril treatment has been shown to reduce coronary events and nephropathy in high risk patients.17, 18 Likewise, treatment with fosinopril and losartan significantly decreased microalbuminuria as well as CVD events.19, 20A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with diabetes and microalbuminuria has been shown to reduce CVD and microvascular events by about 50 percent.21
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