Albuminuria as pre-screening tool for better risk prediction

Abstract

Cardiovascular disease (CVD) and chronic kidney disease (CKD) are common health problems and originates predominantly from generalized atherosclerosis. Diabetes, hypertension, and hypercholesterolemia are well known risk factors for atherosclerosis. Screening for and treatment of these risk factors is the cornerstone for prevention of CVD and CKD. Elevated albuminuria has increasingly been recognized as first evidence of generalized atherosclerosis. Testing for albuminuria is thus far advocated only in case of the presence of the abovementioned risk factors. In this thesis, that is a part of the PREVEND study, it is investigated, whether pre-screening for albuminuria followed by screening for diabetes, hypertension and hypercholesterolemia only in those subjects with elevated albuminuria may be of help to improve the effectiveness of screening for and treatment of CVD and CKD. It was found that in subjects with elevated albuminuria the prevalence of yet undiagnosed CV risk factors is high. The identification of subjects with elevated albuminuria and a newly diagnosed risk factor is important, because these subjects were shown to be at increased risk for both CVD and progressive CKD, especially in subjects ≥55 years of age. In addition, the start of statin treatment in hypercholesterolaemic subjects with elevated albuminuria was associated with a better risk reduction in CV event rate. In conclusion, this thesis shows that pre-screening for albuminuria will make screening to identify subjects at high risk for CVD and progressive CKD more efficient. Those with elevated albuminuria should be invited for further screening for risk factors, and should be treated according to the current guidelines