Background Even the earliest subclinical renal dysfunction is an important independent risk factor for cardiovascular disease . It is cardiovascular complications associated with atherosclerotic vascular disease that are the leading causes of premature mortality in rheumatoid arthritis (RA) .
Objectives To determine the urinary excretions of albumin in patients with RA, to identify the relationship of this indicator with risk factors for cardiovascular disease.
Methods The study included 73 patients with RA at the age 18 to 60 years, who were treated at the rheumatology department of the regional hospital. Exclusion criteria were an associated kidney diseases, hypertension stage III, any kind of secondary nephropathy and pregnancy. We investigated the urinary excretions of albumin (Al) by immunoturbidimetric method in a morning urine sample. The urinary albumin excretion was considered normal for the index of Al/urine creatinine less than 17 mg/g in men and 25 mg/g in women. The arterial stiffness was detected using a Tensioclinic arteriograph (Tensiomed, Hungary). The pulse wave velocity in the aortaand augmentation index were measured. The ultrasound measuring of the carotid intima-media thickness was performed to study subclinical atherosclerosis.
Results The urinary excretion of Al in the patients with RA was significantly higher than in control subjects matched for age, body mass index, blood pressure (50.27 [23.2, 100.82] mg/g and 23.43 [17.92, 30.42] mg/g, respectively, p<0.001). Increased urinary albumin excretion was found in 52 (71%) patients. The correlation was found of the urinary excretion of Al with age (r = 0.266; p = 0.023), the multiplicity of nonsteroid anti-inflammatory drugs (NSAIDs) in the month prior to the study (r = 0.271; p = 0.027), glomerular filtration rate, which was calculated by using the Modification of Diet in Renal Disease (r = -0.282; p = 0.016), low density lipoprotein (r= 0.367; p = 0.005), atherogenic index (r = 0.415; p = 0.001), pulse wave velocity in the aorta (r = 0.258; p = 0.039), augmentation index in the aorta and brachial artery (r = 0.346; p = 0.005), the carotid intima-media thickness (r = 0.270; p = 0.021).
Conclusions The urinary excretion of Al in the patients with RA is significantly higher than in the control group. Increased urinary albumin excretion correlates with risk factors for cardiovascular disease (hypertension, dyslipidemia, the arterial stiffness) and with the features of the development of the RA (multiple NSAIDs).
Astor B.C., Hallan S.I.Miller E.R. et al. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. American Journal of Epidemiology2008;167:1226-1233
CaplanM. J. Cardiovasculardiseaseinrheumatoidarthritis. Curr. Opin. Rheumatol., 2006;18:289-97.
Disclosure of Interest None Declared