Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis
Hernán Trimarchi1, Alexis Muryan2, Mariana Dicugno2, Pablo Young3, Mariano Forrester1, Fernando Lombi1, Vanesa Pomeranz1, Romina Iriarte1, María Soledad Raña1, Mirta Alonso21Nephrology, 2Biochemistry, 3Internal Medicine Services, Hospital Brit&aac...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2011-12-01
|
| Series: | International Journal of Nephrology and Renovascular Disease |
| Online Access: | http://www.dovepress.com/proteinuria-an-ignored-marker-of-inflammation-and-cardiovascular-disea-a8951 |
| _version_ | 1818344300593807360 |
|---|---|
| author | Trimarchi H Muryan A Dicugno M Young P Forrester M Lombi F Pomeranz V Iriarte R Raña MS Alonso M |
| author_facet | Trimarchi H Muryan A Dicugno M Young P Forrester M Lombi F Pomeranz V Iriarte R Raña MS Alonso M |
| author_sort | Trimarchi H |
| collection | DOAJ |
| description | Hernán Trimarchi1, Alexis Muryan2, Mariana Dicugno2, Pablo Young3, Mariano Forrester1, Fernando Lombi1, Vanesa Pomeranz1, Romina Iriarte1, María Soledad Raña1, Mirta Alonso21Nephrology, 2Biochemistry, 3Internal Medicine Services, Hospital Británico de Buenos Aires, ArgentinaBackground: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients, the main etiologies being diabetes and hypertension. Cardiac and inflammatory biomarkers are usually employed to assess risk or damage, or during follow-up. Proteinuria is considered a strong predictor of morbidity, a cause of inflammation, oxidative stress, hemodynamic alteration, and progression of chronic kidney disease. However, proteinuria is rarely considered in the clinical assessment of HD patients.Methods: This was a concurrent, cohort-observational, cross-sectional study in which 52 chronic HD subjects were divided into three groups according to the degree of proteinuria: Group (G) A: <1 g/day, n = 25; GB: 1–3 g/day, n = 13; GC: >3 g/day, n = 14. Baseline hemoglobin, albuminemia, cholesterol, body mass index, Malnutrition-Inflammatory Score, pro-B-type natriuretic peptide, troponin T, C-reactive protein (CRP), and ultrafiltration rates were analyzed.Results: There was no difference between groups in terms of baseline age, gender, hypertension, cause of renal failure, hemoglobin, cholesterol, albumin, CRP levels, cardiac biomarkers, adiponectin, body mass index, or Malnutrition-Inflammatory Score. Time on HD: GA, 34.56 ± 23.3 (range [r]: 6–88); GB, 25.15 ± 19.40 (r: 6–58); GC, 18.21 ± 9.58 (r: 6–74) months; P = 0.048. Proteinuria: GA, 0.33 ± 0.30 (r: 0.0–0.88); GB, 1.66 ± 0.54 (r: 1.03–2.75); GC, 7.18 ± 2.80 (r: 3.04–21.5) g/day; P < 0.001. Mean ultrafiltration rates were significantly different: GA, 2.80 ± 0.73; GB: 1.85 ± 0.96 liters/session; P = 0.003. Fourteen diabetic patients were identified (27%): GA, 3 (12%); GB, 3 (23%); GC, 8 (57%); P = 0.009. A positive and significant correlation was observed between diabetes and proteinuria >3 g/day: rho 0.438, P = 0.027. Although troponin T, pro-B-type natriuretic peptide, adiponectin, and CRP were not different among groups, the positive correlation between troponin T and CRP elevated significantly as proteinuria increased: GA, rho 377, P = 0.063; GB, rho 663, P = 0.013; GC, rho 687, P = 0.007.Conclusion: In chronic HD, nephrotic-range proteinuria was significantly higher in diabetic nephropathy patients versus other causes. This was associated with inflammation and cardiac stress and was independent of fluid removal. Proteinuria >3 g/day was associated with shorter time on HD. Whether severe proteinuria is associated with shorter survival in HD, independent of diabetes, is to be determined. Proteinuria should be considered in the assessment of cardiovascular and inflammatory states in HD patients.Keywords: hemodialysis, proteinuria, inflammation, cardiovascular risk |
| first_indexed | 2024-12-13T16:44:17Z |
| format | Article |
| id | doaj.art-34766974cc314f4a89f5f324f1487d67 |
| institution | Directory Open Access Journal |
| issn | 1178-7058 |
| language | English |
| last_indexed | 2024-12-13T16:44:17Z |
| publishDate | 2011-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of Nephrology and Renovascular Disease |
| spelling | doaj.art-34766974cc314f4a89f5f324f1487d672022-12-21T23:38:13ZengDove Medical PressInternational Journal of Nephrology and Renovascular Disease1178-70582011-12-012012default17Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysisTrimarchi HMuryan ADicugno MYoung PForrester MLombi FPomeranz VIriarte RRaña MSAlonso MHernán Trimarchi1, Alexis Muryan2, Mariana Dicugno2, Pablo Young3, Mariano Forrester1, Fernando Lombi1, Vanesa Pomeranz1, Romina Iriarte1, María Soledad Raña1, Mirta Alonso21Nephrology, 2Biochemistry, 3Internal Medicine Services, Hospital Británico de Buenos Aires, ArgentinaBackground: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients, the main etiologies being diabetes and hypertension. Cardiac and inflammatory biomarkers are usually employed to assess risk or damage, or during follow-up. Proteinuria is considered a strong predictor of morbidity, a cause of inflammation, oxidative stress, hemodynamic alteration, and progression of chronic kidney disease. However, proteinuria is rarely considered in the clinical assessment of HD patients.Methods: This was a concurrent, cohort-observational, cross-sectional study in which 52 chronic HD subjects were divided into three groups according to the degree of proteinuria: Group (G) A: <1 g/day, n = 25; GB: 1–3 g/day, n = 13; GC: >3 g/day, n = 14. Baseline hemoglobin, albuminemia, cholesterol, body mass index, Malnutrition-Inflammatory Score, pro-B-type natriuretic peptide, troponin T, C-reactive protein (CRP), and ultrafiltration rates were analyzed.Results: There was no difference between groups in terms of baseline age, gender, hypertension, cause of renal failure, hemoglobin, cholesterol, albumin, CRP levels, cardiac biomarkers, adiponectin, body mass index, or Malnutrition-Inflammatory Score. Time on HD: GA, 34.56 ± 23.3 (range [r]: 6–88); GB, 25.15 ± 19.40 (r: 6–58); GC, 18.21 ± 9.58 (r: 6–74) months; P = 0.048. Proteinuria: GA, 0.33 ± 0.30 (r: 0.0–0.88); GB, 1.66 ± 0.54 (r: 1.03–2.75); GC, 7.18 ± 2.80 (r: 3.04–21.5) g/day; P < 0.001. Mean ultrafiltration rates were significantly different: GA, 2.80 ± 0.73; GB: 1.85 ± 0.96 liters/session; P = 0.003. Fourteen diabetic patients were identified (27%): GA, 3 (12%); GB, 3 (23%); GC, 8 (57%); P = 0.009. A positive and significant correlation was observed between diabetes and proteinuria >3 g/day: rho 0.438, P = 0.027. Although troponin T, pro-B-type natriuretic peptide, adiponectin, and CRP were not different among groups, the positive correlation between troponin T and CRP elevated significantly as proteinuria increased: GA, rho 377, P = 0.063; GB, rho 663, P = 0.013; GC, rho 687, P = 0.007.Conclusion: In chronic HD, nephrotic-range proteinuria was significantly higher in diabetic nephropathy patients versus other causes. This was associated with inflammation and cardiac stress and was independent of fluid removal. Proteinuria >3 g/day was associated with shorter time on HD. Whether severe proteinuria is associated with shorter survival in HD, independent of diabetes, is to be determined. Proteinuria should be considered in the assessment of cardiovascular and inflammatory states in HD patients.Keywords: hemodialysis, proteinuria, inflammation, cardiovascular riskhttp://www.dovepress.com/proteinuria-an-ignored-marker-of-inflammation-and-cardiovascular-disea-a8951 |
| spellingShingle | Trimarchi H Muryan A Dicugno M Young P Forrester M Lombi F Pomeranz V Iriarte R Raña MS Alonso M Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis International Journal of Nephrology and Renovascular Disease |
| title | Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| title_full | Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| title_fullStr | Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| title_full_unstemmed | Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| title_short | Proteinuria: an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| title_sort | proteinuria an ignored marker of inflammation and cardiovascular disease in chronic hemodialysis |
| url | http://www.dovepress.com/proteinuria-an-ignored-marker-of-inflammation-and-cardiovascular-disea-a8951 |
| work_keys_str_mv | AT trimarchih proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT muryana proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT dicugnom proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT youngp proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT forresterm proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT lombif proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT pomeranzv proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT iriarter proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT raampntildeams proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis AT alonsom proteinuriaanignoredmarkerofinflammationandcardiovasculardiseaseinchronichemodialysis |