Albuminuria, but not estimated glomerular filtration rate, is associated with maladaptive arterial remodeling: the Hoorn Study.
OBJECTIVE
Arterial remodeling aims to maintain a constant circumferential wall stress (sigmac). A failing remodeling process is associated with stroke. Data on the relationship between chronic kidney disease and arterial remodeling are scarce.


METHODS
We investigated the association between a lower glomerular filtration rate (GFR) and microalbuminuria with arterial remodeling of the common carotid artery (CCA) in a population-based study of 806 patients. CCA properties including intima-media thickness and interadventitial diameter (IAD) were assessed. Lumen diameter, circumferential wall tension (CWT), and circumferential wall stress (sigmac) were calculated. GFR was estimated (eGFR) by the Modification of Diet in Renal Disease formula. Albuminuria was expressed as urinary albumin/creatinine ratio.


RESULTS
Mean eGFR was 60.3 (+/-10.8) ml/min/1.73 m2; median urinary albumin/creatinine ratio was 0.57 (range 0.10-26.6 mg/mmol). After adjustment for age, sex, glucose tolerance status, and prevalent cardiovascular disease, eGFR was not independently associated with CCA properties. A greater urinary albumin/creatinine ratio (per quartile) was associated with a greater lumen diameter [regression coefficient beta with 95% confidence interval, 0.14 (0.08-0.20; P < 0.01)], IAD [0.15 (0.09-0.21; P < 0.01)], CWT [0.95 (0.52-1.38; P < 0.01)], and sigmac [1.7 (0.5-2.9; P < 0.01)] but not with a greater IMT [0.01 (-0.002-0.02; P = 0.12)]. Additional adjustments for mean arterial pressure, pulse pressure, and eGFR did not change the results.


CONCLUSIONS
Greater albuminuria is independently associated with an increase in lumen diameter and IAD of the CCA. In addition, greater albuminuria is associated with a maladaptive carotid remodeling process as shown by an increase in CWT and sigmac. These findings may explain, why microalbuminuria is associated with a greater risk of cardiovascular disease and especially stroke.
Hermans
Marc M H
MM
Division of Nephrology and General Internal Medicine, Department of Internal Medicine, Academic Hospital Maastricht, Maastricht, The Netherlands. mherm@sint.azm.nl
Henry
Ronald M A
RM
Dekker
Jaqueline M
JM
Nijpels
Giel
G
Heine
Rob J
RJ
Stehouwer
Coen D A
CD
D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D003404:Creatinine