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NDT Advance Access originally published online on February 18, 2009
Nephrology Dialysis Transplantation 2009 24(7):2111-2116; doi:10.1093/ndt/gfp042
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© The Author [2009].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Prevalence of microalbuminuria and associated electrocardiographic abnormalities in an Indo-Asian population

Tazeen H. Jafar1,2,3, Zeeshan Qadri2 and Shiraz Hashmi2

1 Section of Nephrology, Department of Medicine 2 Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 3 Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA

Correspondence and offprint requests to: Tazeen H. Jafar; E-mail: tazeen.jafar{at}aku.edu



  Abstract

Background. Microalbuminuria (MA) is a known predictor of cardiovascular disease (CVD) in European origin populations, but such data are lacking in native Indo-Asian populations, where CVD risks are high. Major electrocardiographic (ECG) changes are predictive of cardiovascular mortality. We determined the association of MA with major ECG changes in the general population of Pakistan.

Methods. A total of 3143 subjects aged ≥40 years from 12 randomly selected communities in Karachi participated. MA was defined as the urine albumin to creatinine (ACR) ratio of < 300 mg/g creatinine and ≥17 mg/g in men and ≥25 mg/g in women from a single-spot morning urine sample. Major changes on ECG were coded in duplicate using Minnesota classification.

Results. The mean age of subjects was 51.5 (10.7) years. The median (25–75 percentile) ACR was 4.2 (2.9–7.9) mg/g in men and 6.0 (3.9–10.8) mg/g in women (P < 0.001). The overall prevalence (95% CI) of MA was 12.3% (11.1–13.5%), and 20.3% in those with major ECG changes. In a multivariable model, major ECG changes (OR, 95% CI) (1.50, 1.10–2.00), diabetes (3.57, 2.93–4.35), hypertension (2.30, 1.85–2.86), female sex (0.61, 0.53–0.69), age (1.09, 1.05–1.13, for each 5-year increase) and eGFR (0.80, 0.78–0.81, for each 10 mg/g increase) were independently associated with MA.

The presence of MA increased the prevalence of major ECG changes from 21 to 31% in those with hypertension (44.9%), 15 to 28% among those with diabetes (21.4%), 14 to 26% among those with overweight or obesity (68.4%) and 14 to 26% among current users of tobacco (38.7%) (P < 0.001) each.

Conclusions. The strong association between MA and major ECG changes underscores the importance of screening Indo-Asian subjects for MA for unmasking underlying CVD, especially those with hypertension, diabetes, obesity, and tobacco users.

Keywords: cardiovascular disease; ethnicity; hypertension; microalbuminuria

Received for publication: 17.11.08
Accepted in revised form: 20. 1.09


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