Poor Lung Function Has Inverse Relationship with Microalbuminuria, an Early Surrogate Marker of Kidney Damage and Atherosclerosis: The 5th Korea National Health and Nutrition Examination Survey
Background Despite epidemiological evidences of relationship between poor lung function and atherosclerosis, the relationship between poor lung function and microalbuminuria (MAU), an early surrogate marker of both kidney damage and atherosclerosis, is not well understood. Hence, we plan to investigate the relationship between poor lung function and MAU using multivariate models to adjust for other atherogenic risk factors. Methods We used data from the 5th Korean National Health and Nutrition Examination Survey. Poor lung function is determined by spirometric measurement, primarily through estimation of the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Declines in the percent predicted FVC (<80%) and in the FEV1/FVC ratio (<0.7) are defined as restrictive and obstructive patterns, respectively. Urine albumin to urine creatinine levels ratio (UACR) were measured in spot urine samples. MAU was defined as UACR >30 mg/g. Results Inverse relationship was observed between lung function and UACR. In an age-adjusted regression model, the regression coefficient (B) of 10% lower FVC was 11.09 in men (P = 0.002), which remained significant after adjustment for SBP, FBG, triglyceride level, BMI, smoking history, and heavy alcohol consumption (B = 7.52, P = 0.043). When the restrictive pattern was compared to the normal pattern, the odds ratios (OR) (95% confidence interval, 95%CI) for MAU were 1.90 (1.32–2.72) in men, after adjustment for age, hypertension, diabetes mellitus, triglyceride level, obesity, smoking history, physical activity, and heavy alcohol consumption. Conclusions Our study, the first investigation in Asia, demonstrated that the restrictive pattern is related to MAU in men. Furthermore, there was linear relationship between lower FVC and UACR. Thus, our current study suggests that poor lung function, particularly the restrictive pattern, is related to kidney damage as well as atherosclerosis.
References
[1]
Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B (1995) Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects. Clin Sci (Lond) 88: 629–633.
[2]
Zhang YH, Gao Y, Mao X, Shang J, Su BL (2013) Assessment of carotid atherosclerosis in type 2 diabetes mellitus patients with microalbuminuria by high-frequency ultrasonography. Int J Endocrinol 2013: 819584. doi: 10.1155/2013/819584
[3]
Cerasola G, Cottone S, Mule G (2010) The progressive pathway of microalbuminuria: from early marker of renal damage to strong cardiovascular risk predictor. J Hypertens 28: 2357–2369. doi: 10.1097/hjh.0b013e32833ec377
[4]
de Zeeuw D, Parving HH, Henning RH (2006) Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol 17: 2100–2105. doi: 10.1681/asn.2006050517
[5]
Hansson GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352: 1685–1695. doi: 10.1056/nejmra043430
[6]
Lu Y, Feng L, Feng L, Nyunt MS, Yap KB, et al. (2013) Systemic inflammation, depression and obstructive pulmonary function: a population-based study. Respir Res 14: 53. doi: 10.1186/1465-9921-14-53
[7]
Shibata Y, Inoue S, Igarashi A, Yamauchi K, Abe S, et al. (2013) A lower level of forced expiratory volume in 1 second is a risk factor for all-cause and cardiovascular mortality in a Japanese population: the takahata study. PLoS One 8: e83725. doi: 10.1371/journal.pone.0083725
[8]
Hancox RJ, Poulton R, Greene JM, Filsell S, McLachlan CR, et al. (2007) Systemic inflammation and lung function in young adults. Thorax 62: 1064–1068. doi: 10.1136/thx.2006.076877
[9]
Mercken EM, Hageman GJ, Schols AM, Akkermans MA, Bast A, et al. (2005) Rehabilitation decreases exercise-induced oxidative stress in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 172: 994–1001. doi: 10.1164/rccm.200411-1580oc
[10]
Fimognari FL, Scarlata S, Antonelli-Incalzi R (2010) Why are people with “poor lung function” at increased atherothrombotic risk? A critical review with potential therapeutic indications. Curr Vasc Pharmacol 8: 573–586. doi: 10.2174/157016110791330780
[11]
Nussbaumer-Ochsner Y, Rabe KF (2011) Systemic manifestations of COPD. Chest 139: 165–173. doi: 10.1378/chest.10-1252
[12]
Sin DD, Wu L, Man SF (2005) The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 127: 1952–1959. doi: 10.1378/chest.127.6.1952
[13]
Johnston AK, Mannino DM, Hagan GW, Davis KJ, Kiri VA (2008) Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort. Thorax 63: 599–605. doi: 10.1136/thx.2007.088112
[14]
Mannino DM, Doherty DE, Sonia Buist A (2006) Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med 100: 115–122. doi: 10.1016/j.rmed.2005.03.035
[15]
Orth SR, Stockmann A, Conradt C, Ritz E, Ferro M, et al. (1998) Smoking as a risk factor for end-stage renal failure in men with primary renal disease. Kidney Int 54: 926–931. doi: 10.1046/j.1523-1755.1998.00067.x
[16]
Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, et al. (2011) Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 16: 659–665. doi: 10.1111/j.1440-1843.2011.01951.x
[17]
Choi JK, Paek D, Lee JO (2005) Normal predictive values of spirometry in Korean population. Tuberculosis and Respiratory Diseases 58: 230–242.
[18]
Schroeder EB, Welch VL, Couper D, Nieto FJ, Liao D, et al. (2003) Lung function and incident coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 158: 1171–1181. doi: 10.1093/aje/kwg276
[19]
Won JC, Lee YJ, Kim JM, Han SY, Noh JH, et al. (2013) Prevalence of and factors associated with albuminuria in the Korean adult population: the 2011 Korea National Health and Nutrition Examination Survey. PLoS One 8: e83273. doi: 10.1371/journal.pone.0083273
[20]
Garg JP, Bakris GL (2002) Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vasc Med 7: 35–43. doi: 10.1191/1358863x02vm412ra
[21]
Lee YJ, Kim NK, Yang JY, Noh JH, Lee SS, et al. (2013) Low pulmonary function in individuals with impaired fasting glucose: the 2007–2009 Korea national health and nutrition examination survey. PLoS One 8: e76244. doi: 10.1371/journal.pone.0076244
[22]
Sin DD, Man SF (2003) Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 107: 1514–1519. doi: 10.1161/01.cir.0000056767.69054.b3
[23]
Curkendall SM, Lanes S, de Luise C, Stang MR, Jones JK, et al. (2006) Chronic obstructive pulmonary disease severity and cardiovascular outcomes. Eur J Epidemiol 21: 803–813. doi: 10.1007/s10654-006-9066-1
[24]
Gruffydd-Jones K, Loveridge C (2011) The 2010 NICE COPD Guidelines: how do they compare with the GOLD guidelines? Prim Care Respir J 20: 199–204. doi: 10.4104/pcrj.2011.00011
[25]
Yoon J-H, Choi B-S, Shin J-H, Park S-Y, Lee Y-L, et al. (2012) Association between impaired lung function and coronary artery calcium score in workers exposed to inorganic dust. Toxicology and Environmental Health Sciences 4: 139–142. doi: 10.1007/s13530-012-0128-3
[26]
Mannino DM, Thorn D, Swensen A, Holguin F (2008) Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 32: 962–969. doi: 10.1183/09031936.00012408
[27]
Ferretti A, Giampiccolo P, Cavalli A, Milic-Emili J, Tantucci C (2001) Expiratory flow limitation and orthopnea in massively obese subjects. Chest 119: 1401–1408. doi: 10.1378/chest.119.5.1401
[28]
Mannino DM, Holguin F, Pavlin BI, Ferdinands JM (2005) Risk factors for prevalence of and mortality related to restriction on spirometry: findings from the First National Health and Nutrition Examination Survey and follow-up. Int J Tuberc Lung Dis 9: 613–621.
[29]
van Gestel YR, Flu WJ, van Kuijk JP, Hoeks SE, Bax JJ, et al. (2010) Association of COPD with carotid wall intima-media thickness in vascular surgery patients. Respir Med 104: 712–716. doi: 10.1016/j.rmed.2009.10.027
[30]
Akpinar EE, Akpinar S, Ertek S, Sayin E, Gulhan M (2012) Systemic inflammation and metabolic syndrome in stable COPD patients. Tuberk Toraks 60: 230–237. doi: 10.5578/tt.4018
[31]
Barnes PJ, Celli BR (2009) Systemic manifestations and comorbidities of COPD. Eur Respir J 33: 1165–1185. doi: 10.1183/09031936.00128008
