INTRODUCTION The disease complex comprised of atherosclerosis, chronic kidney disease (CKD) and other associated chronic vascular diseases is the leading cause of mortality worldwide. Microalbuminuria is a marker for vascular damage in the heart, kidney and brain. This paper presents selected findings of the clinical-epidemiological Isle of Youth Study (ISYS) of markers for kidney and vascular damage from chronic vascular diseases and their common risk factors in total population, focusing on Phase 2 reassessment (in 2010) of Phase 1 (2004 to 2006) results.
OBJECTIVES (1) Update the prevalence of risk factors in the study population aged ≥20 years (adult population). (2) Confirm presence of microalbuminuria in at-risk adults diagnosed as presumptive positives in Phase I. (3) Evaluate association between microalbuminuria and selected risk factors.
METHODS Of 3779 adults positive for microalbuminuria in ISYS Phase 1, 73.1% were reevaluated. The risk-factor questionnaire was re-administered and blood pressure, weight and height were measured. Blood was tested for creatinine, glycemia, cholesterol and triglycerides. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Albuminuria was measured in urine using Micral-Test (Germany) and albumin/creatinine ratio (ACR) by nephelometry. This paper uses ACR as the reference for analyzing risk factor associations. Double-entry tables were developed to analyze association among microalbuminuria, risk factors and co-morbidities.
RESULTS Most prevalent risks were hypertension, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), excess weight and hypertriglyceridemia. Microalbuminuria was confirmed in 18% of cases, using the same test. Elevated prevalence of microalbuminuria was positively associated with advancing age, male sex, underweight, smoking, NSAID use, dyslipidemia, hypertension, diabetes, heart disease and stroke.
CONCLUSIONS The at-risk cohort studied presented low levels of confirmation for positive microalbuminuria. Positive microalbuminuria stratified individuals at greatest risk, except for obesity.
KEYWORDS Chronic kidney disease, cardiovascular disease, risk factors, damage markers, albuminuria, microalbuminuria, Cuba
Introduction Obesity is a social disease constituting a global pandemic. It is present in 90% of diabetic and 65% of hypertensive patients. It is associated with cardiometabolic syndrome and with damaging physiopathological mechanisms, particularly for the vascular system and the kidneys. On Cuba’s Isle of Youth, a community-based epidemiological study of chronic kidney disease (CKD), hypertension (HTN), diabetes mellitus (DM) and cardio-cerebral vascular disease was carried out in total population, including an examination of common risk factors.
Objective Based on the Isle of Youth Study (ISYS) data, determine prevalence of obesity and overweight, and their association with CKD, HTN, DM, and shared risk factors for all these conditions in total population of the Isle of Youth, Cuba.
Methods Phase 1: Population diagnosis (November 2004-April 2006): 96.6% of the Isle of Youth’s total population (80,117) was studied, including all ages and both sexes. Information was offered to the public, and written informed consent obtained. Screening was conducted by participant questionnaire including risk factors, physical measurements (weight, height, blood pressure and body mass index), and a single first-morning urine sample to determine the presence of vascular-renal damage markers – proteinuria and hematuria (Combur 10 Test, Roche), and microalbuminuria (Micral Test, Roche). When results were positive, serum creatinine was determined and glomerular filtration rate (GFR) estimated with Modification of Diet in Renal Disease (MDRD) formula for adults and Schwartz formula for children <15 years. Data obtained were analyzed to determine association of participants’ nutritional status with prevalence of chronic kidney disease, hypertension and diabetes mellitus, as well as a set of common risk factors.
Results Population <20 years: Obesity prevalence 3.2%; positive urine markers in 56.9% of obese and 8.9% of non-obese participants; positive albuminuria in 38% of obese and 3% of non-obese. Obese participants were found to be hyperfiltrating. DM prevalence was 9.5% in obese and 1.1% in non-obese participants. Population ≥20 years: Overweight, 31.3%; obese, 13.4%. Positive markers in normal-weight, overweight and obese individuals were 18.3%, 21.2% and 32.7%, respectively; microalbuminuria values increased with weight. Obese individuals were found to be hyperfiltrating. HTN prevalence in normal-weight, overweight and obese individuals was 18.3%, 31.5%, and 51.0% respectively; DM rates were 2.8%, 5.2% y 11.3%, respectively.
Conclusion In Cuba, obesity poses significant risk for vascular and renal damage and should be the focus of increased prevention efforts.
Keywords Vascular diseases, chronic kidney disease, CKD, chronic kidney insufficiency, hypertension, diabetes mellitus, risk factors, obesity, overweight, body mass index, glomerular filtration rate
The methodology is described in detail for the population-based Isle of Youth Study (ISYS) for epidemiological evaluation of CKD associated with cardio-cerebral vascular disease, arterial hypertension, diabetes mellitus, and other risk factors.
Background: Chronic kidney disease emerges as an important and growing global health problem associated with an increase in the incidence and prevalence of the above mentioned diseases.
ISYS Objectives: Ascertain CKD morbidity and its relation to chronic vascular diseases and other risk factors in whole population of Cuba’s Isle of Youth special municipality.
Method: 96.6% of the Isle of Youth’s total population (80,117 inhabitants) was studied, all ages and both sexes, November 15, 2004-April 30, 2006. The public was offered general information on the objectives and benefits of the study, and participants provided informed consent. Active screening was performed via personal interview questionnaire and urine sample to determine markers of kidney damage: proteinuria and hematuria (Combur-10-Test) and microalbuminuria (Micral-Test), according to a diagnostic algorithm. For those testing positive for any marker, serum creatinine was studied and glomerular filtration rate (GFR) calculated – in adults by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) formulas and in children aged <15 years, by Schwartz – to stratify CKD by stages. Blood pressure, height, weight, and body mass index (BMI) were determined.
Expected Results: Prevalence of kidney damage markers in general population and risk groups; relationship in population between CKD and cardio-cerebral vascular disease, diabetes mellitus, hypertension, and other risk factors; comparison of Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) formulas for measuring the GFR and their application to studies involving mass population screenings; and stratification of CKD in population.
Conclusions: ISYS Phase I, active screening of markers for renal damage was concluded using the methodology described above; results are pending publication. (Abstract)
