ó Simple tests used regularly to assess kidney function and
damage also could help doctors predict who will suffer heart
disease, the nationís leading cause of death, researchers
from the Johns Hopkins Bloomberg School of Public Health have
tests are just as good, if not better, than standard
cholesterol and blood pressure tests, potentially giving
doctors a better idea of which patients to more closely watch
or treat, said Dr. Kunihiro Matsushita, an assistant scientist
in the schoolís department of epidemiology who led the
levels and blood pressure tests are good indicators of
cardiovascular risk, but they are not perfect," he said.
"This study tells us we could do even better with
information that oftentimes we are already collecting."
tests assess kidney function by measuring a waste product in
blood called creatinine and kidney damage by measuring a
protein in urine called albumin.
tests are frequently used because kidney disease is common (26
million people in the United States are affected) and because
many professional associations as well as official government
advisers recommend the tests to track people with diabetes and
hypertension, as well as kidney disease.
kidney function test, called "estimated glomerular
filtration rate" or eGFR, is given 290 million times a
year, the researchers said.
is thinking about developing calculators that could more
specifically spell out how much more risk different people of
different nationalities and backgrounds face based on
increases in creatinine and albumin levels.
doctors would have a better handle on how much risk
individuals have particularly for heart failure, when blood
isnít pumping normally; heart attack, when a clot blocks
normal blood flow; or stroke, when a clot blocks blood flow to
could prevent some death and disability by recommending
medications or lifestyle changes such as increased exercise or
data show that every year in the United States more than
735,000 people have a heart attack and 610,000 people die of
about half of those with heart disease have an indicator such
as high blood pressure or high cholesterol, or smoke,
according the U.S. Centers for Disease Control and Prevention.
donít fully understand why there is such a strong
association particularly between kidney damage and risk of
heart trouble. But they said those with chronic kidney disease
have twice the chance of developing cardiovascular disease
than those with healthy kidneys.
at Hopkinsí Chronic Kidney Disease Prognosis Consortium
analyzed data from 24 studies, including more than 637,000
people with no history of cardiovascular disease and the
results of their kidney function and damage tests.
found albumin specifically was a better predictor than
standard tests in general, and an even stronger predictor in
African-Americans. Generally, the higher the albumin level,
the higher the risk.
tests are still not likely to be used on the general
population to predict heart disease, said Dr. Josef Coresh,
coordinator of the Hopkins kidney consortium and director of
the Bloomberg Schoolís G.W. Comstock Center for Public
Health Research & Prevention.
Preventive Services Task Force, which advises the government,
doesnít recommend the tests for adults with no symptoms of
believe that the findings, published in May in the medical
journal Lancet Diabetes and Endocrinology, support using the
tests on people who are at risk of cardiovascular disease.
would help doctors intervene "and save lives," said
Dr. Leslie Spry, the medical director of the Dialysis Center
of Lincoln in Lincoln, Neb., and a spokesman for the National
kidney patients die of heart maladies than wind up in
end-stage kidney disease and on dialysis, but there hasnít
been a way to predict which ones would have heart problems.
my 30 years of doing this, Iíve always felt people with
kidney disease and protein in their urine were a different
breed than people who donít have the protein," Spry
said. "If you have the albumin, you have a greater chance
of dying of heart disease. Theyíve made the link."
more people should be advised to diet and exercise, quit
smoking and even go on medications, he said. There also should
be more trials to see if statins widely used to lower
cholesterol in heart patients are safe for kidney patients.
Jeffrey Quartner, chief of cardiology at MedStar Union
Memorial Hospital, agreed it would be helpful to know earlier
who might develop potentially fatal heart problems.
the kidney tests could serve as a "red flag" and
could add to the overall evaluation of a patient. But he
cautioned that it should not be the only test a doctor
evaluation, considering all the risk factors ó such as other
health problems, lifestyle choices and family history ó
would help a doctor determine if steps such as medications are
necessary, he said.
called the study a "good first observation" and said
calculators showing more specific risk would be even more
doctors want to do is identify people earlier who may be at
risk for a problem and put them on the right pathway, and
ultimately reduce their risk and keep them healthier as they
age," he said.
real take-home here is if you find there is damage to kidneys
and the patient has not yet had anyone look at their heart
function," he said, "they ought to be looked