rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-06-09rpcardio-2499Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТNew Possibilities in Quantitative Assessment of Albuminuria in Patients with Atrial Fibrillation and Chronic Kidney DiseaseНовые возможности количественной оценки альбуминурии у пациентов с фибрилляцией предсердий и хронической болезнью почекhttps://orcid.org/0000-0001-5938-8917СоколоваА. А.SokolovaA. A.

Соколова Анастасия Андреевна

Москва

Anastasiya A. Sokolova

Moscow

https://orcid.org/0000-0001-6753-1365СкрипкаА. И.SkripkaA. I.

Скрипка Алена Игоревна

Москва

Alena I. Skripka

Moscow

alenskripka@yandex.ruhttps://orcid.org/0000-0003-3438-069XИвановИ. И.IvanovI. I.

Иванов Илья Игоревич

Москва

Ilya I. Ivanov

Moscow

https://orcid.org/0000-0002-7802-1843КогайВ. В.KogayV. V.

Когай Вероника Валерьяновна

Москва

Veronika V. Kogay

Moscow

https://orcid.org/0000-0002-0401-1132ЛистратовА. И.ListratovA. I.

Листратов Александр Иванович

Москва

Alexander I. Listratov

Moscow

https://orcid.org/0000-0002-3959-9482ГиндисА. А.GindisA. A.

Гиндис Алла Александровна

Москва

Alla A. Gindis

Moscow

https://orcid.org/0000-0001-5938-8917НапалковД. А.NapalkovD. A.

Напалков Дмитрий Александрович - eLibrary SPIN 2894-5010

Москва

Dmitry A. Napalkov - eLibrary SPIN 2894-5010

Moscow

Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuing Professional EducationRussian Federation202112072021173423428Copyright © Sokolova A.A., Skripka A.I., Ivanov I.I., Kogay V.V., Listratov A.I., Gindis A.A., Napalkov D.A., 20212021Соколова А.А., Скрипка А.И., Иванов И.И., Когай В.В., Листратов А.И., Гиндис А.А., Напалков Д.А.Sokolova A.A., Skripka A.I., Ivanov I.I., Kogay V.V., Listratov A.I., Gindis A.A., Napalkov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2499Aim

Aim. To evaluate the relationship between albumin to creatinine ratio (ACR) in a single and 24-hours urine spots and chronic kidney disease (CKD) progression pace in patients with atrial fibrillation, CKD and diabetes mellitus.

Material and methods

Material and methods. 60 patients with atrial fibrillation (AF) and CKD were enrolled, study duration was 15 months. The patients were divided into two groups depending on the presence of DM. Total number of ACR tests was 170, dynamics of CKD progression was estimated with CKD-EPI formula for first visit and 15th month’s follow-up.

Results

Results. The median score of CHA2DS2VASс scale was 4 [3;5]. The risk of hemorrhagic complications in both groups was low (median score 1 [1;1]. There is a strong statistically significant correlation between ACR in a single and 24-hours urine spots (p<0.001). No significant changes in kidney function within 15 months were found (GFR 53 [46;59] ml/min/1.73 m2 vs 50.5 [45.63] ml/min/1.73 m2 for patients with diabetes mellitus [DM] [p=0.94] and GFR 52.5 [46.58] ml/min/1.73 m2 vs 50 [44.58] ml/min/1.73 m2 for patients without DM [p=0.711]). When comparing the renal function of patients with and without DM after 15 months statistically significant differences were also not found (p = 0.510).

Conclusion

Conclusion. In respect that assessment of single sample ACR is much more practical and reliable, this method might replace traditional 24-hours urine assessment in future. However, due to the small sample size and the presence of wide discrepancies in individual cases, which can be associated with preanalytical errors in urine collection, large randomized clinical trials are needed to confirm the obtained data.

Цель

Цель. Сравнить воспроизводимость исследования альбумин-креатининового соотношения (ACR) в разовой и суточной порциях мочи. Оценить взаимосвязь между ACR в разовой и суточной порциях мочи c темпами прогрессирования почечной недостаточности у пациентов с фибрилляцией предсердий (ФП), хронической болезнью почек (ХБП) и сахарным диабетом (СД).

Материал и Методы

Материал и Методы. В исследование включены 60 пациентов с ФП и ХБП 3А стадии. Пациенты были поделены на две группы в зависимости от наличия СД 2 типа. Длительность периода наблюдения составила 15 мес. Общее количество тестов ACR составило 170. Динамика прогрессирования ХБП оценивалась по степени изменения скорости клубочковой фильтрации (СКФ), рассчитанной с помощью формулы CKD-EPI для первого визита и 15-го месяца наблюдения.

Результаты

Результаты. Медиана баллов по шкале риска тромбоэмболических осложнений CHA2DS2VASс составила 4 [3;5]. Риск геморрагических осложнений в обеих группах пациентов был низким (медиана 1 [1;1]). Была получена сильная статистически значимая корреляция между ACR в разовой порции и суточной порции мочи (p<0,001). За весь период наблюдения, который составил 15 мес, не было обнаружено статистически значимых изменений почечной функции: СКФ 53 [46; 59] мл/мин/1,73 м2 против 50,5 [45; 63] мл/мин/1,73 м2 для пациентов с СД (p=0,94) и СКФ 52,5 [46; 58] мл/мин/1,73 м2 против 50 [44; 58] мл/мин/1,73 м2 для пациентов без СД (p=0,711). Через 15 мес наблюдения группы пациентов с СД и без СД по уровню почечной функции между собой не различались (p=0,510).

Заключение

Заключение. В связи с тем, что оценка ACR одного образца гораздо более практична и надежна, этот метод может в будущем заменить более трудоемкое суточное исследование альбуминурии мочи. Однако, в силу небольшой величины выборки и наличия широких расхождений в отдельных случаях, которые могут быть связаны с преаналитическими ошибками в сборе мочи, для подтверждения полученных данных необходимо проведение крупных рандомизированных клинических исследований.

альбумин-креатининовое отношениехроническая болезнь почекфибрилляция предсердийсахарный диабетальбуминурияalbumin to creatinine ratiochronic kidney diseaseatrial fibrillationdiabetes mellitusalbuminuriaИсследование проведено при поддержке Сеченовского УниверситетаThe study was performed with the support of the Sechenov UniversityReferencesBenjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. DOI:10.1161/CIR.0000000000000659.Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. DOI:10.1161/CIR.0000000000000659.Go AS, Fang MC, Udaltsova N, et al. Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation. 2009;119(10):1363-9. DOI:10.1161/CIRCULATIONAHA.108.816082.Go AS, Fang MC, Udaltsova N, et al. Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation. 2009;119(10):1363-9. DOI:10.1161/CIRCULATIONAHA.108.816082.Bansal N, Zelnick LR, Alonso A, et al. eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clin J Am Soc Nephrol CJASN. 2017;12(9):1386-98. DOI:10.2215/CJN.01860217.Bansal N, Zelnick LR, Alonso A, et al. eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clin J Am Soc Nephrol CJASN. 2017;12(9):1386-98. DOI:10.2215/CJN.01860217.Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020;98(4S):S1-S115. DOI:10.1016/j.kint.2020.06.019.Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020;98(4S):S1-S115. DOI:10.1016/j.kint.2020.06.019.Reinecke H, Brand E, Mesters R, et al. Dilemmas in the management of atrial fibrillation in chronic kidney disease. J Am Soc Nephrol JASN. 2009;20(4):705-11. DOI:10.1681/ASN.2007111207.Reinecke H, Brand E, Mesters R, et al. Dilemmas in the management of atrial fibrillation in chronic kidney disease. J Am Soc Nephrol JASN. 2009;20(4):705-11. DOI:10.1681/ASN.2007111207.Nasri H, Rafieian-Kopaei M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci Off J Isfahan Univ Med Sci. 2015;20(11):1112-20. DOI:10.4103/1735-1995.172845.Nasri H, Rafieian-Kopaei M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci Off J Isfahan Univ Med Sci. 2015;20(11):1112-20. DOI:10.4103/1735-1995.172845.Ezekowitz MD, Connolly S, Parekh A, et al. Rationale and design of RE-LY: randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran. Am Heart J. 2009;157(5):805-10. DOI:10.1016/j.ahj.2009.02.005.Ezekowitz MD, Connolly S, Parekh A, et al. Rationale and design of RE-LY: randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran. Am Heart J. 2009;157(5):805-10. DOI:10.1016/j.ahj.2009.02.005.Böhm M, Ezekowitz MD, Connolly SJ, et al. Changes in Renal Function in Patients With Atrial Fibrillation: An Analysis From the RE-LY Trial. J Am Coll Cardiol. 2015;65(23):2481-93. DOI:10.1016/j.jacc.2015.03.577.Böhm M, Ezekowitz MD, Connolly SJ, et al. Changes in Renal Function in Patients With Atrial Fibrillation: An Analysis From the RE-LY Trial. J Am Coll Cardiol. 2015;65(23):2481-93. DOI:10.1016/j.jacc.2015.03.577.Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet Lond Engl. 2010;375(9731):2073-81. DOI:10.1016/S0140-6736(10)60674-5.Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet Lond Engl. 2010;375(9731):2073-81. DOI:10.1016/S0140-6736(10)60674-5.Astor BC, Matsushita K, Gansevoort RT, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011;79(12):1331-40. DOI:10.1038/ki.2010.550.Astor BC, Matsushita K, Gansevoort RT, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011;79(12):1331-40. DOI:10.1038/ki.2010.550.van der Velde M, Matsushita K, Coresh J, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79(12):1341-52. DOI:10.1038/ki.2010.536.van der Velde M, Matsushita K, Coresh J, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79(12):1341-52. DOI:10.1038/ki.2010.536.Lamb EJ, MacKenzie F, Stevens PE. How should proteinuria be detected and measured? Ann Clin Biochem. 2009;46(Pt 3):205-17. DOI:10.1258/acb.2009.009007.Lamb EJ, MacKenzie F, Stevens PE. How should proteinuria be detected and measured? Ann Clin Biochem. 2009;46(Pt 3):205-17. DOI:10.1258/acb.2009.009007.Koopman MG, Krediet RT, Koomen GC, et al. Circadian rhythm of proteinuria: consequences of the use of urinary protein:creatinine ratios. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 1989;4(1):9-14.Koopman MG, Krediet RT, Koomen GC, et al. Circadian rhythm of proteinuria: consequences of the use of urinary protein:creatinine ratios. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 1989;4(1):9-14.Huan L, Yuezhong L, Chao W, HaiTao T. The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China. Clin Sao Paulo Braz. 2016;71(5):243-250. DOI:10.6061/clinics/2016(05)01Huan L, Yuezhong L, Chao W, HaiTao T. The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China. Clin Sao Paulo Braz. 2016;71(5):243-250. DOI:10.6061/clinics/2016(05)01Vart P, Scheven L, Lambers Heerspink HJ, et al. Urine Albumin-Creatinine Ratio Versus Albumin Excretion for Albuminuria Staging: A Prospective Longitudinal Cohort Study. Am J Kidney Dis Off J Natl Kidney Found. 2016;67(1):70-8. DOI:10.1053/j.ajkd.2015.05.025.Vart P, Scheven L, Lambers Heerspink HJ, et al. Urine Albumin-Creatinine Ratio Versus Albumin Excretion for Albuminuria Staging: A Prospective Longitudinal Cohort Study. Am J Kidney Dis Off J Natl Kidney Found. 2016;67(1):70-8. DOI:10.1053/j.ajkd.2015.05.025.Medcalf EA, Newman DJ, Gorman EG, Price CP. Rapid, robust method for measuring low concentrations of albumin in urine. Clin Chem. 1990;36(3):446-9.Medcalf EA, Newman DJ, Gorman EG, Price CP. Rapid, robust method for measuring low concentrations of albumin in urine. Clin Chem. 1990;36(3):446-9.Sparkenbaugh EM, Chantrathammachart P, Mickelson J, et al. Differential contribution of FXa and thrombin to vascular inflammation in a mouse model of sickle cell disease. Blood. 2014;123(11):1747-56. DOI:10.1182/blood-2013-08-523936.Sparkenbaugh EM, Chantrathammachart P, Mickelson J, et al. Differential contribution of FXa and thrombin to vascular inflammation in a mouse model of sickle cell disease. Blood. 2014;123(11):1747-56. DOI:10.1182/blood-2013-08-523936.Lee I-O, Kratz MT, Schirmer SH, Baumhäkel M, Böhm M. The effects of direct thrombin inhibition with dabigatran on plaque formation and endothelial function in apolipoprotein E-deficient mice. J Pharmacol Exp Ther. 2012;343(2):253-7. DOI:10.1124/jpet.112.194837.Lee I-O, Kratz MT, Schirmer SH, Baumhäkel M, Böhm M. The effects of direct thrombin inhibition with dabigatran on plaque formation and endothelial function in apolipoprotein E-deficient mice. J Pharmacol Exp Ther. 2012;343(2):253-7. DOI:10.1124/jpet.112.194837.Bea F, Kreuzer J, Preusch M, et al. Melagatran reduces advanced atherosclerotic lesion size and may promote plaque stability in apolipoprotein E-deficient mice. Arterioscler Thromb Vasc Biol. 2006;26(12):2787-92. DOI:10.1161/01.ATV.0000246797.05781.ad.Bea F, Kreuzer J, Preusch M, et al. Melagatran reduces advanced atherosclerotic lesion size and may promote plaque stability in apolipoprotein E-deficient mice. Arterioscler Thromb Vasc Biol. 2006;26(12):2787-92. DOI:10.1161/01.ATV.0000246797.05781.ad.

The authors declare that there are no conflicts of interest present.