Microvascular endothelial dysfunction is associated with albuminuria: the Maastricht Study : Journal of Hypertension

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ORIGINAL PAPERS: Blood vessels

Microvascular endothelial dysfunction is associated with albuminuria

the Maastricht Study

Martens, Remy J.H.a,b; Houben, Alfons J.H.M.c,d; Kooman, Jeroen P.a,b; Berendschot, Tos T.J.M.e; Dagnelie, Pieter C.d,f,g; van der Kallen, Carla J.H.c,d; Kroon, Abraham A.c,d; Leunissen, Karel M.L.a,b; van der Sande, Frank M.a; Schaper, Nicolaas C.c,d,f; Schouten, Jan S.A.G.e; Schram, Miranda T.c,d,h; Sep, Simone J.S.c,d; Sörensen, Ben M.c,d; Henry, Ronald M.A.c,d,h; Stehouwer, Coen D.A.c,d

Author Information

aDivision of Nephrology, Department of Internal Medicine, Maastricht University Medical Center+

bNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University

cDepartment of Internal Medicine, Maastricht University Medical Center+

dCARIM School for Cardiovascular Diseases, Maastricht University

eDepartment of Ophthalmology, Maastricht University Medical Center+

fCAPHRI School for Public Health and Primary Care

gDepartment of Epidemiology, Maastricht University

hHeart and Vascular Centre, Maastricht University Medical Center+, Maastricht, the Netherlands

Correspondence to Coen D.A. Stehouwer, Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202AZ, Maastricht, the Netherlands. Tel: +31 433877006; fax: +31 433875006; e-mail: [email protected]

Abbreviations: CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; CVD, cardiovascular disease; DVA, dynamic vessel analyzer; eGFR, estimated glomerular filtration rate; HbA1c, hemoglobin A1c; NO, nitric oxide; Q, quartile; UAE, urinary albumin excretion; VEGF, vascular endothelial growth factor

Received 11 September, 2017

Revised 13 December, 2017

Accepted 18 December, 2017

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

Journal of Hypertension 36(5):p 1178-1187, May 2018. | DOI: 10.1097/HJH.0000000000001674

Abstract

Objective: 

Albuminuria is thought to be a biomarker of microvascular and macrovascular endothelial dysfunction. However, direct evidence for an association of microvascular endothelial dysfunction with albuminuria is limited. In addition, experimental data suggest a stronger association of microvascular endothelial dysfunction with albuminuria in individuals with than in those without diabetes.

Methods: 

We examined cross-sectional associations of flicker light-induced retinal arteriolar dilation (n = 2095) and heat-induced skin hyperemia (n = 1508) with 24-h albuminuria in the population-based, diabetes-enriched Maastricht Study. We used linear regression analyses to adjust for age, sex, type 2 diabetes, and cardiovascular disease risk factors. In addition, we tested for statistical interaction with type 2 diabetes.

Results: 

Median [interquartile range] albuminuria was 6.5 [3.9–11.6] mg/24 h and 8.2% had albuminuria at least 30 mg/24 h. After adjustment, albuminuria was 1.168 (95% confidence interval, 1.046–1.303) times greater in participants in the quartile with the smallest flicker light-induced retinal arteriolar dilation relative to those with the greatest dilation, and this association was stronger in participants with type 2 diabetes (Pinteraction < 0.10). Further, each 100 percentage points lower heat-induced skin hyperemia was associated with a 1.022 (1.010–1.035) times greater albuminuria in participants with type 2 diabetes, whereas it was not associated with albuminuria in nondiabetic participants (Pinteraction < 0.10).

Conclusion: 

This is the first population-based study that provides direct evidence that microvascular endothelial dysfunction is associated with albuminuria, and that this association is stronger in individuals with than in those without type 2 diabetes.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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