Albuminuria Predicting Outcome in Diabetes
Kidney International (2004) 66, S42–S44; doi:10.1111/j.1523-1755.2004.09211.x
Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: Further evidence for a link between microalbuminuria and endothelial dysfunction—The Hoorn Study
COEN D A STEHOUWER, RONALD M A HENRY, JACQUELINE M DEKKER, GIEL NIJPELS, ROBERT J HEINE and LEX M BOUTER
Departments of Internal Medicine and Endocrinology, Institutes for Cardiovascular Research and for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
Correspondence: Coen D.A. Stehouwer, Professor and Chair, Department of Medicine, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: csteh@sint.azm.nl
Abstract
Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: Further evidence for a link between microalbuminuria and endothelial dysfunction—The Hoorn Study.
Background
Extensive endothelial dysfunction (i.e., affecting many aspects of endothelial function) has been hypothesized to explain why microalbuminuria (MA) is associated with cardiovascular disease risk. However, it is not clear whether MA is specifically associated with impaired endothelial nitric oxide (NO) synthesis in individuals without and with type 2 diabetes.
Methods
We did a population-based study in 645 individuals (mean age 68 years; 248 with normal glucose metabolism, 137 with impaired glucose metabolism, and 260 with type 2 diabetes) and investigated associations of MA [present (urinary albumin-creatinine ratio 
2 mg/mmol) versus absent, and in four categories (<2, 2 to 5, 5 to 10, 10 mg/mmol)] with ultrasonically measured brachial artery endothelium-dependent, flow-mediated (FMD; an estimate of endothelial NO synthesis) and endothelium-independent, nitroglycerin-induced vasodilation (NID).
Results
FMD was 0.12 mm in the presence of MA (N=93; 49 with diabetes), and 0.18 in its absence (P=0.002). After adjustment for age, sex, baseline arterial diameter, and other potential confounders, FMD was 0.038 mm (95% CI, 0.001 to 0.075) lower in the presence of MA (P=0.04), and decreased linearly across MA categories [by 0.027 mm (0.007 to 0.046) per category increase of MA; P=0.007]. NID was similar in individuals with and without MA. Results were similar in individuals without and with diabetes.
Conclusion
Microalbuminuria is linearly associated with impaired endothelium-dependent, flow-mediated vasodilation in elderly individuals without and with diabetes. These findings support the concept that impaired endothelial nitric oxide synthesis plays a role in the association of microalbuminuria with cardiovascular disease risk.
Keywords:
albumin excretion, endothelium, cardiovascular disease, diabetes
MORE ARTICLES LIKE THIS
These links to content published by NPG are automatically generated
RESEARCH
Kidney International Original Article
Troglitazone-Induced Changes in Adiponectin Do Not Affect Endothelial Function in Diabetes **
Obesity Research Original Article
Kidney International Original Article
Albuminuria, not only a cardiovascular/renal risk marker, but also a target for treatment?
Kidney International Original Article
