Top

High Blood Pressure & Cardiovascular Prevention

Published in:

01-12-2014 | Review Article

Early Renal Abnormalities as an Indicator of Cardiovascular Risk in Type 2 Diabetes

Authors: Francesca Viazzi, Barbara Bonino, Elena Ratto, Salvatore De Cosmo, Roberto Pontremoli

Published in: High Blood Pressure & Cardiovascular Prevention | Issue 4/2014

Abstract

Accurate assessment of cardiovascular (CV) risk is a prerequisite for devising effective therapeutic strategies in patients with type 2 diabetes (T2DM) as it allows to refine prognosis and treatment targets as well as the cost-benefit ratio for specific pharmacological interventions. The presence of subclinical vascular organ damage plays a well known role in determining overall risk and a wider use of low cost, easy to perform diagnostic tools to stratify CV risk is very much needed. Besides their well known prognostic value for progression to end stage renal disease (ESRD), subclinical renal abnormalities such as microalbuminuria and/or a slight reduction in estimation of glomerular filtration rate (eGFR), have been shown to be powerful, independent predictors of CV diseases in patients with T2DM. Through the combined evaluation of these two biomarkers of chronic kidney disease (CKD), clinicians can usefully and reliably get a perspective on global and CV outcome of their diabetic patients.

ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013;2013(31):1925–38.

Viazzi F, Leoncini G, Parodi D, Ratto E, Vettoretti S, Vaccaro V, Parodi A, Falqui V, Tomolillo C, Deferrari G, Pontremoli R. Impact of target organ damage assessment in the evaluation of global risk in patients with essential hypertension. J Am Soc Nephrol. 2005;16(Suppl 1):S89–91.PubMedCrossRef

Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. UKPDS Group Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003;63:225–32.PubMedCrossRef

Haynes R, Staplin N, Emberson J, Herrington GW, Tomson C, Agodoa L, Tesar V, Levin A, Lewis D, Reith C, Baigent C, Landray MJ, SHARP Collaborative Group. Evaluating the Contribution of the Cause of Kidney Disease to Prognosis in CKD: Results From the Study of Heart and Renal Protection (SHARP). Am J Kidney Dis. 2014;64:40–8.PubMedCentralPubMedCrossRef

Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, Lee BJ, Perkins RM, Rossing P, Sairenchi T, Tonelli M, Vassalotti JA, Yamagishi K, Coresh J, de Jong PE, Wen CP, Nelson RG, Chronic Kidney Disease Prognosis Consortium. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662–73.PubMedCentralPubMedCrossRef

Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, Gansevoort RT, Kasiske BL, Eckardt KU. The definition, classification and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int. 2011;80:17–28.PubMedCrossRef

Leoncini G, Viazzi F, Pontremoli R. Overall health assessment: a renal perspective. Lancet. 2010;375(9731):2053–4.PubMedCrossRef

Ekinci EI, Jerums G, Skene A, Crammer P, Power D, Cheong KY, Panagiotopoulos S, McNeil K, Baker ST, Fioretto P. Macisaac RJ Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013;36:3620–6.PubMedCentralPubMedCrossRef

De Cosmo S, Rossi MC, Pellegrini F, Lucisano G, Bacci S, Gentile S, Ceriello A, Russo G, Nicolucci A, Giorda C, Viazzi F, Pontremoli R, AMD-Annals Study Group. Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes. Nephrol Dial Transplant. 2014;29:657–62.PubMedCrossRef

10.

Pugliese G, Solini A, Fondelli C, Trevisan R, Vedovato M, Nicolucci A, Penno G, Renal Insufficiency and Cardiovascular Events (RIACE) Study Group. Reproducibility of albuminuria in type 2 diabetic subjects. Findings from the Renal Insufficiency and Cardiovascular Events (RIACE) study. Nephrol Dial Transplant. 2011;26:3950–4.PubMedCrossRef

11.

Solini A, Penno G, Bonora E, Fondelli C, Orsi E, Arosio M, Trevisan R, Vedovato M, Cignarelli M, Andreozzi F, Nicolucci A, Pugliese G, Renal Insufficiency and Cardiovascular Events (RIACE) Study Group. Diverging association of reduced glomerular filtration rate and albuminuria with coronary and noncoronary events in patients with type 2 diabetes: the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study. Diabetes Care. 2012;35:143–9.PubMedCentralPubMedCrossRef

12.

Tonelli M, Muntner P, Lloyd A, Manns BJ, James MT, Klarenbach S, Quinn RR, Wiebe N, Hemmelgarn BR, Alberta Kidney Disease Network. Using proteinuria and estimated glomerular filtration rate to classify risk in patients with chronic kidney disease. A cohort study. Ann Intern Med. 2011;154:12–21.PubMedCrossRef

13.

Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1982;1(8287):1430–2.PubMedCrossRef

14.

De Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006;17:2100–5.PubMedCrossRef

15.

Viazzi F, Garneri D, Leoncini G, Gonnella A, Muiesan ML, Ambrosioni E, Costa FV, Leonetti G, Pessina AC, Trimarco B, Volpe M, Agabiti Rosei E, Deferrari G, Pontremoli R. Serum uric acid and its relationship with metabolic syndrome and cardiovascular risk profile in patients with hypertension: insights from the I-DEMAND study. Nutr Metab Cardiovasc Dis. 2014. doi:10.1016/j.numecd.2014.01.018. [Epub ahead of print].

16.

Leoncini G, Viazzi F, Parodi D, Vettoretti S, Ratto E, Ravera M, Tomolillo C, Del Sette M, Bezante GP, Deferrari G, Pontremoli R. Mild renal dysfunction and subclinical cardiovascular damage in primary hypertension. Hypertension. 2003;42:14–8.PubMedCrossRef

17.

Ninomiya T, Perkovic V, de Galan BE, Zoungas S, Pillai A, Jardine M, Patel A, Cass A, Neal B, Poulter N, Mogensen CE, Cooper M, Marre M, Williams B, Hamet P, Mancia G, Woodward M, Macmahon S, Chalmers J, ADVANCE Collaborative Group. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. J Am Soc Nephrol. 2009;20:1813–21.PubMedCentralPubMedCrossRef

18.

Marshall SM. Natural history and clinical characteristics of CKD in type 1 and type 2 diabetes mellitus. Adv Chronic Kidney Dis. 2014;21:267–72.PubMedCrossRef

19.

Ruggenenti Piero, Porrini Esteban, Motterlini Nicola, Perna Annalisa, Ilieva Aneliya Parvanova, Iliev Ilian Petrov, Dodesini Alessandro Roberto, Trevisan Roberto, Bossi Antonio, Sampietro Giuseppe, Capitoni Enrica, Gaspari Flavio, Rubis Nadia, Ene-Iordache Bogdan, Remuzzi Giuseppe, BENEDICT Study Investigators. Measurable urinary albumin predicts cardiovascular risk among normoalbuminuric patients with type 2 diabetes. J Am Soc Nephrol. 2012;23:1717–24.PubMedCentralPubMedCrossRef

20.

Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Snapinn SM, Wan Y, Lyle PA. Does albuminuria predict cardiovascular outcomes on treatment with losartan versus atenolol in patients with diabetes, hypertension, and left ventricular hypertrophy? The LIFE study. Diabetes Care. 2006;29:595–600.PubMedCrossRef

21.

Schmieder RE, Mann JF, Schumacher H, Gao P, Mancia G, Weber MA, McQueen M, Koon T, Yusuf S, ONTARGET Investigators. Changes in albuminuria predict mortality and morbidity in patients with vascular disease. J Am Soc Nephrol. 2011;22:1353–64.PubMedCentralPubMedCrossRef

22.

Savarese G, Dei Cas A, Rosano G, D’Amore C, Musella F, Mosca S, Reiner MF, Marchioli R, Trimarco B, Perrone-Filardi P. Reduction of albumin urinary excretion is associated with reduced cardiovascular events in hypertensive and/or diabetic patients. A meta-regression analysis of 32 randomized trials. Int J Cardiol. 2014;172:403–10.PubMedCrossRef

23.

Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, Trevisan R, Vedovato M, Gruden G, Cavalot F, Cignarelli M, Laviola L, Morano S, Nicolucci A, Pugliese G, Renal Insufficiency and Cardiovascular Events (RIACE) Study Group. Clinical significance of nonalbuminuric renal impairment in type 2 diabetes. J Hypertens. 2011;29:1802–9.PubMedCrossRef

24.

Pugliese G, Solini A, Bonora E, Orsi E, Zerbini G, Fondelli C, Gruden G, Cavalot F, Lamacchia O, Trevisan R, Vedovato M, Penno G, RIACE Study Group. Distribution of cardiovascular disease and retinopathy in patients with type 2 diabetes according to different classification systems for chronic kidney disease: a cross-sectional analysis of the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study. Cardiovasc Diabetol. 2014;13:59. doi:10.1186/1475-2840-13-59.PubMedCentralPubMedCrossRef

25.

Haller H, Menne J, Mancia G. Awareness and behaviour of European physicians in relation to microalbuminuria and organ damage: an ESH-endorsed survey. J Hypertens. 2010;28:2204–9.PubMedCrossRef

26.

Ko SH, Kwon HS, Kim DJ, Kim JH, Kim NH, Kim CS, Song KH, Won JC, Lim S, Choi SH, et al. Higher prevalence and awareness, but lower control rate of hypertension in patients with diabetes than general population: the fifth Korean national health and nutrition examination survey in 2011. Diabetes Metab J. 2014;38:51–7.PubMedCentralPubMedCrossRef

Title: Early Renal Abnormalities as an Indicator of Cardiovascular Risk in Type 2 Diabetes
Authors: Francesca Viazzi
Barbara Bonino
Elena Ratto
Salvatore De Cosmo
Roberto Pontremoli
Publication date: 01-12-2014
Publisher: Springer International Publishing
Published in: High Blood Pressure & Cardiovascular Prevention / Issue 4/2014
Print ISSN: 1120-9879
Electronic ISSN: 1179-1985
DOI: https://doi.org/10.1007/s40292-014-0067-y

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

Early Renal Abnormalities as an Indicator of Cardiovascular Risk in Type 2 Diabetes

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2014

Therapeutic Approaches to Chronic Hyperuricemia and Gout

Vitamin D and Cardiometabolic Disorders

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Immune Mechanisms in Hypertension

Hyperuricemia and cardiovascular risk

A Randomized Controlled Trial of the Effects of Aerobic Dance Training on Blood Lipids Among Individuals with Hypertension on a Thiazide

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page