Background/Aims: Albuminuria is a risk factor for coronary artery calcification (CAC) and cardiovascular disease (CVD). Although the urine dipstick test is widely used to screen albuminuria, little is known about the association between low-grade urine dipstick albumin and CAC. The aim of this study is to investigate the relationship between the trace of urine dipstick albumin and CAC in Korean adults. Methods: This cross-sectional study analyzed 45,006 participants without previous CVD, who underwent coronary computed tomography and urine dipstick test from 2012 to 2014 as part of a health examination program in Korea. CAC was defined as coronary artery calcium score > 100. Participants were divided into 3 groups based on urine dipstick albumin results as follows: negative (–), trace (±), and positive (+1 to +4). Results: The numbers of participants with CAC were 800 (2.0%), 111 (2.8%), and 33 (4.9%) for the negative, trace, and positive groups respectively. Based on multivariate analysis, albuminuria determined with urine dipstick test was associated with CAC after adjustment for various cardiovascular risk factors. Compared with the negative group, the OR for CAC was 1.62 (1.08–2.42) in the positive group and 1.34 (1.07–1.66) in the trace group. Conclusion: Even a trace level of albumin in the urine dipstick test was associated with subclinical CAC in Korean adults. Low-grade dipstick albuminuria should not be overlooked.

Keywords:
Urine dipstick test, Trace, Albuminuria, Coronary artery calcification
1.
KDIGO: KDIGO Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, 2012.
2.
Burton C, Harris KP: The role of proteinuria in the progression of chronic renal failure. Am J Kidney Dis 1996; 27: 765–775.
3.
Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT: Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010; 375: 2073–2081.
4.
Kondos GT, Hoff JA, Sevrukov A, et al: Electron-beam tomography coronary artery calcium and cardiac events: A 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation 2003; 107: 2571–2576.
5.
Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ: Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003; 228: 826–833.
6.
Santos RD, Nasir K: Insights into atherosclerosis from invasive and non-invasive imaging studies: Should we treat subclinical atherosclerosis? Atherosclerosis 2009; 205: 349–356.
7.
Bellasi A, Lacey C, Taylor AJ, Raggi P, Wilson PW, Budoff MJ, Vaccarino V, Shaw LJ: Comparison of prognostic usefulness of coronary artery calcium in men versus women (results from a meta- and pooled analysis estimating all-cause mortality and coronary heart disease death or myocardial infarction). Am J Cardiol 2007; 100: 409–414.
8.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J: A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.
9.
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.
10.
Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ, Zelinger A, Mahmarian JJ: Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation 2000; 101: 850–855.
11.
Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, Friedman JD, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A: Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 2004; 44: 923–930.
12.
Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med 2004; 164: 1285–1292.
13.
Yamagami K, Hosoi M, Yamamoto T, Fukumoto M, Yamakita T, Miyamoto M, Yoshioka K, Ishii T, Sato T, Tanaka S, Fujii S: Coronary arterial calcification is associated with albuminuria in type 2 diabetic patient. Diabetes Obes Metab 2005; 7: 390–396.
14.
Kramer H, Jacobs DR Jr, Bild D, Post W, Saad MF, Detrano R, Tracy R, Cooper R, Liu K: Urine albumin excretion and subclinical cardiovascular disease. The Multi-Ethnic Study of Atherosclerosis. Hypertension 2005; 46: 38–43.
15.
Costacou T, Edmundowicz D, Prince C, Conway B, Orchard TJ: Progression of coronary artery calcium in type 1 diabetes mellitus. Am J Cardiol 2007; 100: 1543–1547.
16.
DeFilippis AP, Kramer HJ, Katz R, Wong ND, Bertoni AG, Carr J, Budoff MJ, Blumenthal RS, Nasir K: Association between coronary artery calcification progression and microalbuminuria: the MESA study. JACC Cardiovasc Imaging 2010; 3: 595–604.
17.
Shimbo Y, Suzuki S, Ishii H, Shibata Y, Tatami Y, Harata S, Osugi N, Ota T, Tanaka A, Shibata K, Mizukoshi T, Yasuda Y, Maruyama S, Murohara T: Association of estimated glomerular filtration rate and proteinuria with lipid-rich plaque in coronary artery disease. Circ J 2015; 79: 2263–2270.
18.
Jang CM, Hyun YY, Lee KB, Kim H: Insulin resistance is associated with the development of albuminuria in Korean subjects without diabetes. Endocrine 2015; 48: 203–210.
19.
Blaha MJ, DeFilippis AP, Rivera JJ, Budoff MJ, Blankstein R, Agatston A, Szklo M, Lakoski SG, Bertoni AG, Kronmal RA, Blumenthal RS, Nasir K: The relationship between insulin resistance and incidence and progression of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2011; 34: 749–751.
20.
Gupta J, Mitra N, Kanetsky PA, Devaney J, Wing MR, Reilly M, Shah VO, Balakrishnan VS, Guzman NJ, Girndt M, Periera BG, Feldman HI, Kusek JW, Joffe MM, Raj DS: Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC. Clin J Am Soc Nephrol 2012; 7: 1938–1946.
21.
Bessueille L, Magne D: Inflammation: a culprit for vascular calcification in atherosclerosis and diabetes. Cell Mol Life Sci 2015; 72: 2475–2489.
22.
Paisley KE, Beaman M, Tooke JE, Mohamed-Ali V, Lowe GD, Shore AC: Endothelial dysfunction and inflammation in asymptomatic proteinuria. Kidney Int 2003; 63: 624–633.
23.
von Scholten BJ, Reinhard H, Hansen TW, Schalkwijk CG, Stehouwer C, Parving HH, Jacobsen PK, Rossing P: Markers of inflammation and endothelial dysfunction are associated with incident cardiovascular disease, all-cause mortality, and progression of coronary calcification in type 2 diabetic patients with microalbuminuria. J Diabetes Complications 2016; 30: 248–255.
24.
Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL: Laboratory Assessment of Kidney Disease: Glomerular Filtration Rate, Urinalysis, and Proteinuria: Brenner & Rector’s the kidney. Philadelphia, PA, Elsevier, 2016.
© 2018 S. Karger AG, Basel
2018
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