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The clinical utilization of albuminuria as a surrogate measure of cardiovascular disease burden and risk for events: are we there yet?

Introduction There is unequivocal epidemiologic evidence that microalbuminuria is a marker of increased cardiovascular morbidity and mortality in both diabetic and nondiabetic populations [1]. Moreover, microalbuminuria progresses to overt proteinuria in a substantial proportion of patients. Framingham Heart Study observations also indicate that proteinuria is predictive of cardiovascular mortality in both men and women [2]. Why then has not more effort been placed on using this simple test as a screening tool to evaluate patients for cardiovascular disease risk in conjunction with other proven test methods? A urine albumin or protein-to-creatinine ratio is simple, inexpensive, and painless, and, along with the blood pressure, cholesterol, and glucose, provides enormous opportunity to identify patients with smallblood-vessel disease in the kidney, which is likely reflective of both small and large-blood-vessel disease throughout the body. However, is the link between proteinuria and cardiovascular disease the same if glomerular filtration rate is not decreased below 60 ml/ min per 1.73 m? Should we not also consider whether strategies which reduce albuminuria might also reduce the risk for cardiovascular events regardless of renal function? Might prevention of the development of microalbuminuria also prove to be a surrogate endpoint of success of a given regimen?