Although a low glomerular filtration rate (GFR) and albuminuria have previously been independently linked with an increased risk of cardiovascular disease, it has not been established whether either measurement adds additional prognostic information beyond that of traditional cardiovascular risk factors.

Using data from the ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized Assessment Study in Angiotensin-Converting-Enzyme-Inhibitor Intolerant Subjects with Cardiovascular Disease) studies, Clase and colleagues studied 27,620 patients over the age of 55 years.  All patients had documented cardiovascular disease and the mean length of follow-up was 4.6 years.

The authors confirmed that lower eGFRs and higher urinary albumin-creatinine ratios were associated with the primary cardiovascular composite outcome, however they also noted that adding these measurements to traditional cardiovascular risk factors led to no meaningful decrease in the number of patients categorised as intermediate risk (31% without vs. 32% with).  However, the authors did note that these measurements greatly improved risk stratification capacity in the prediction of the likelihood of long-term dialysis.

Conclusions:

In this study of patients at high cardiovascular risk, urinary albumin-creatinine level and GFR added little to traditional cardiovascular risk factors in the estimation of cardiovascular risk, however they greatly improved risk stratification for renal outcomes.

• Clase CM, Gao P, Tobe SW et al.  Estimated Glomerular Filtration Rate and Albuminuria as Predictors of Outcomes in Patients With High Cardiovascular Risk.  Annals of Internal Medicine 2011; 154: 310-318.