Editorial [ Has the Time Come for a New Definition of Microalbuminuria?

Abstract

Similar results were obtained from a post-hoc analysis of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, which included patients with hypertension and left ventricular hypertrophy [23]. Among nondiabetic patients, for every 10-fold increase in UACR, the hazard ratios (HR) for the composite endpoint increased by 57%, for CV mortality by 97.7%, for all cause mortality by 75.2%, for stroke by 51% and for myocardial infarction by 45% (p<0.001 for all comparisons). Ratios were similar in diabetic patients, although for myocardial infarction the trend was weaker and not significant. This study showed a prognostic value for UACR at a level below the current definition of MA, whereas the risk for the composite CV endpoint increased continuously as albuminuria increased. A positive dose-response relationship between increasing UAE and mortality was found in 40,548 inhabitants of Groningen, the Netherlands [10]. After adjustment for other wellrecognized CV risk factors, a higher UAE increased the risk of both CV and non-CV death, with a significantly higher rise for CV mortality than for non-CV mortality (p=0.014). A 2-fold increase in UAE was associated with a RR of 1.29 for CV mortality and 1.12 for non-CV mortality. This relationship was already apparent at levels of albuminuria currently considered as normal.