title: Subclinical renal insufficiency range of estimated glomerular filtration rate and microalbuminuria are independently associated with increased arterial stiffness in never treated hypertensives.
abstract: OBJECTIVE
  Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (≥60 mL/min/1.73 m(2)) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin.
  
  
  METHODS
  Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, 50.1±10.4 years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR ≥90 mL/min/1.73 m(2) (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/1.73 m(2) (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU.
  
  
  RESULTS
  Group 1 had the lowest hfPWV (964.6±145.4; group 2, 1013.5±168.9; group 3, 1058.2±238.0; group 4, 1065.8±162.9 cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048).
  
  
  CONCLUSIONS
  Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Seoul, Korea.
authors.forename: Deuk-Young
authors.initials: DY
authors.lastname: Nah
authors.forename: Chang Geun
authors.initials: CG
authors.lastname: Lee
authors.forename: Jun-Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Moo-Yong
authors.initials: MY
authors.lastname: Rhee
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Young-Kwon
authors.initials: YK
authors.lastname: Kim
authors.forename: Myoung-Mook
authors.initials: MM
authors.lastname: Lee
keywords: Arterial stiffness; Glomerular filtration rate; Renal insufficiency