Should albuminuria be a focus of antihypertensive therapy goals?
Albuminuria has been recognized as a risk marker for both chronic kidney disease and cardiovascular disease in large observational cohorts. In addition, post hoc analyses of many large randomized trials have found a positive relationship between albu minuria and adverse renal and cardiovascular outcomes, leading some to suggest that albuminuria may be a potential therapeutic target for antihypertensive treatment. However, direct clinical evidence linking albuminuria reduction to reduction in adverse renal and cardiovascular events is scarce. This paper reviews the evidence in the current literature to address whether albuminuria can be used as a credible predictor of risk for chronic kidney disease and cardiovascular disease and also reviews the clinical trial evidence to appraise the prospect of using albuminuria as a therapeutic target to prevent adverse renal and cardiovascular events.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.United States Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2008.Google Scholar
- 12.Remuzzi A, Ruggenenti P, Mosconi L, et al.: Effect of low-dose enalapril on glomerular size selectivity in human diabetic nephropathy. J Nephrol 1993, 6:36–43.Google Scholar
- 31.Parving HH, Lehnert H, Brochner-Mortenson J, et al., for The Irbesartan in Patients With Type 2 Diabetes and Micro-Albuminuria Study Group: The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001, 345:870–878.PubMedCrossRefGoogle Scholar
- 34.Steines W, Piehlmeier W, Schenkirsch G, et al.: Effectiveness of a disease management programme for patients with type 2 diabetes mellitus and albuminuria in primary care—the PROSIT project (Proteinuria Screening and Intervention). Exp Clin Endocrinol Diabetes 2004, 112:88–94.PubMedCrossRefGoogle Scholar