Abstract
Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.
Highlights
Increased urine protein excretion is a validated risk factor for end stage kidney disease (ESKD), and cardiovascular morbidity and mortality [1,2,3]. microalbuminuria defined as urine excretion between 30 and 300 mg albumin per 24 h, has been used as an early marker for diabetic kidney disease [4, 5], and has been recognized as an important marker for cardiovascular disease (CVD) in the diabetic and the non-diabetic populations [6, 7].Following kidney transplantation recipients become a unique chimera, in which the renal vasculature is different from that of the other organs
This is an interesting setting to explore the link between microalbuminuria and CVD, as the kidney endothelium, that facilitate most of the leakage of protein into the urine, represents the donor rather than the recipient
Microalbuminuria was present in 121 patients (42.5%) and was associated with higher systolic blood pressure, use of antihypertensive medications, hyperlipidemia, higher blood creatinine, higher BMI, a living donor, and the use of mTOR inhibitors
Summary
Increased urine protein excretion is a validated risk factor for end stage kidney disease (ESKD), and cardiovascular morbidity and mortality [1,2,3]. microalbuminuria defined as urine excretion between 30 and 300 mg albumin per 24 h, has been used as an early marker for diabetic kidney disease [4, 5], and has been recognized as an important marker for cardiovascular disease (CVD) in the diabetic and the non-diabetic populations [6, 7].Following kidney transplantation recipients become a unique chimera, in which the renal vasculature is different from that of the other organs. Weiner et al showed that microalbuminuria, as evaluated by albumin creatinine ratio (ACR), had a non-significant trend for association with increased risk of CVD in patients after kidney transplantation [9]. An analysis from our institute showed proteinuria, using urine dipstick, was significantly associated with an increased risk of major cardiovascular adverse events (MACE) [10]. This association was not evaluated by the gold standard of timed urine collection. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection
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