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Low-grade albuminuria in pulmonary arterial hypertension
Nils P Nickel1,2, Vinicio A de Jesus Perez1, Roham T Zamanian1
11 Stanford University School of Medicine, Stanford University, USA.
Abstract:
Low-grade albuminuria, determined by the urinary albumin to creatinine ratio, has been linked to systemic vascular dysfunction and is associated with cardiovascular mortality. Pulmonary arterial hypertension is related to mutations in the bone morphogenetic protein receptor type 2, pulmonary vascular dysfunction and is increasingly recognized as a systemic disease. In a total of 283 patients (two independent cohorts) diagnosed with pulmonary arterial hypertension, 18 unaffected BMPR2 mutation carriers and 68 healthy controls, spot urinary albumin to creatinine ratio and its relationship to demographic, functional, hemodynamic and outcome data were analyzed. Pulmonary arterial hypertension patients and unaffected BMPR2 mutation carriers had significantly elevated urinary albumin to creatinine ratios compared with healthy controls ( P < 0.01; P = 0.04). In pulmonary arterial hypertension patients, the urinary albumin to creatinine ratio was associated with older age, lower six-minute walking distance, elevated levels of C-reactive protein and hemoglobin A1c, but there was no correlation between the urinary albumin to creatinine ratio and hemodynamic variables. Pulmonary arterial hypertension patients with a urinary albumin to creatinine ratio above 10 µg/mg had significantly higher rates of poor outcome ( P < 0.001). This study shows that low-grade albuminuria is prevalent in pulmonary arterial hypertension patients and is associated with poor outcome. This study shows that albuminuria in pulmonary arterial hypertension is associated with systemic inflammation and insulin resistance.
Insights
Low-grade albuminuria (urinary albumin to creatinine ratio) is common in pulmonary arterial hypertension (PAH) and linked to poor outcomes. This condition also correlates with systemic inflammation and insulin resistance in PAH patients.
Area of Science:
- Nephrology
- Cardiology
- Pulmonology
- Genetics
Background:
- Low-grade albuminuria, indicated by urinary albumin to creatinine ratio (UACR), is a marker for systemic vascular dysfunction and cardiovascular mortality.
- Pulmonary arterial hypertension (PAH) involves bone morphogenetic protein receptor type 2 (BMPR2) mutations, pulmonary vascular dysfunction, and is recognized as a systemic disease.
Purpose of the Study:
- To investigate the prevalence and clinical significance of low-grade albuminuria in patients with pulmonary arterial hypertension (PAH).
- To explore the relationship between UACR and demographic, functional, hemodynamic, and outcome data in PAH patients and BMPR2 mutation carriers.
Main Methods:
- Analysis of spot urinary albumin to creatinine ratio (UACR) in 283 PAH patients, 18 unaffected BMPR2 mutation carriers, and 68 healthy controls across two cohorts.
- Correlation of UACR with demographic, functional (six-minute walking distance), inflammatory (C-reactive protein), metabolic (hemoglobin A1c), and hemodynamic variables.
- Assessment of UACR's association with patient outcomes.
Main Results:
- Elevated UACR was observed in PAH patients and unaffected BMPR2 mutation carriers compared to healthy controls.
- In PAH patients, higher UACR correlated with older age, reduced six-minute walking distance, and elevated C-reactive protein and hemoglobin A1c.
- PAH patients with UACR >10 µg/mg exhibited significantly higher rates of poor outcomes.
Conclusions:
- Low-grade albuminuria is prevalent in pulmonary arterial hypertension and is associated with systemic inflammation and insulin resistance.
- Elevated UACR in PAH patients is a predictor of poor clinical outcomes.
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