J Korean Med Sci.  2016 Mar;31(3):382-388. 10.3346/jkms.2016.31.3.382.

Urinary Albumin Excretion and Vascular Function in Rheumatoid Arthritis

• Pieringer
• Brummaier
• Piringer B
• Auer-Hackenberg L
• Hartl A
• Puchner R
• Pohanka E
• Schmid M

• KMID: 2363498
• DOI: http://doi.org/10.3346/jkms.2016.31.3.382

Abstract

Rheumatoid arthritis (RA) is associated with significant cardiovascular (CV) morbidity and mortality. Increased urinary albumin excretion is a marker of CV risk. There are only few data on urinary albumin excretion in RA patients. Aim of the present study was to investigate urinary albumin excretion in RA patients and analyze, whether there is an association between urinary albumin excretion and vascular function as measured by the augmentation index (AIx). In a total of 341 participants (215 with RA, 126 without RA) urinary albumin-creatinine ratio (ACR) was determined and the AIx was measured. The Kolmogorov-Smirnov-test was used to cluster patient groups whose distributions of ACR can be considered to be equal. A crude analysis showed a median ACR of 6.6 mg/g in the RA group and 5.7 mg/g in patients without RA (P > 0.05). In order to account for diabetes (DM) we formed 4 distinct patient groups. Group 1: RA-/DM- (n = 74); group 2: RA+/DM- (n = 195); group 3: RA-/DM+ (n = 52); group 4: RA+/DM+ (n = 20). Clustering of these groups revealed two distinct patient groups: those without RA and DM, and those with either RA or DM or both. The latter group showed statistically significant higher ACR (median 8.1 mg/g) as the former (median 4.5 mg/g). We found no significant correlation between AIx and ACR. Urinary albumin excretion in patients with RA or DM or both is higher than in subjects without RA and DM. This can be seen as a sign of vascular alteration and increased CV risk in these patients.

Keyword

Albuminuria; Rheumatoid Arthritis; Augmentation Index; Diabetes

MeSH Terms

Aged
Albumins/analysis
Albuminuria/*complications
Arthritis, Rheumatoid/complications/*diagnosis
Cardiovascular Diseases/etiology
Cluster Analysis
Creatinine/urine
Diabetes Mellitus, Type 2/complications
Female
Humans
Male
Middle Aged
Pulse Wave Analysis
Risk Factors
Vascular Stiffness/*physiology
Albumins
Creatinine

Figure

• 

  Fig. 1 Cumulative distribution functions of ACR. Empirical cumulative distribution functions (CDFs) F_1, F_2, F_3, F_4, F_5, and F_6 of each of the four different patient samples and their corresponding unions. A logarithmically scaled x-axis (ACR) was used. At the end of the clustering process we have F_1 (small dotted line; no RA and no DM) and F_6 (black solid line; either RA or DM or both). ACR, albumin-creatinine ratio.

• 

  Fig. 2 ACR according to group 1 and 6. Circles and stars depict outliers and extreme outliers, respectively. The plot scale has been set to [0,60] in order to better examine the different levels of the medians. The median of ACR in group 1 is 4.5 mg/g, the median of ACR in group 6 is 8.1 mg/g (one-sided Mann-Whitney U-test, P < 0.001). ACR, albumin-creatinine ratio.

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