Key result
Elevated urinary angiotensinogen excretion was independently associated with increased aortic blood pressures, pulsatile measures of renal blood flow, and plasma NT-proBNP levels.
Why the study?
Inappropriate activation of the intrarenal renin-angiotensin system may contribute to cardio-renal syndrome pathogenesis, but its cross-sectional associations with central and renal hemodynamics required investigation.
Cross-Sectional (n=282)
No
Effect estimate: β 0.219
p-value: p=<0.001
Urinary angiotensinogen excretion is a shared determinant of central and renal hemodynamics, suggesting that intrarenal renin-angiotensin system activity plays a role in the pathophysiology of cardio-renal syndrome.
Urinary AGT may mark shared hemodynamic changes in CRS; hypothesis-generating and should not yet change practice.
Inappropriate activation of intrarenal renin-angiotensin system (RAS) may contribute to the pathogenesis of cardio-renal syndrome (CRS). We aimed to examine the cross-sectional associations of urinary angiotensinogen (AGT) excretion, a biomarker of intrarenal RAS activity, with central (aortic) and renal hemodynamic parameters in middle-aged and older adults, including patients with chronic kidney disease. Aortic and renal hemodynamic parameters were measured using applanation tonometry and duplex ultrasonography in 282 participants. Urinary AGT, liver-type fatty acid-binding protein (L-FABP), and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured for each participant. Multiple linear regression analyses demonstrated that urinary AGT levels were associated with aortic blood pressures, pulsatile measures of renal blood flow, plasma NT-proBNP and urinary L-FABP levels after adjusting for potential covariates, including age, sex, body mass index, estimated glomerular filtration rate (GFR), and medication use. Additionally, when classified based on GFR stages and urinary AGT levels, plasma NT-proBNP and urinary L-FABP levels increased in participants with lower GFR and higher AGT groups. Our findings suggest that urinary AGT excretion is a shared determinant of central (aortic) and renal hemodynamics in middle-aged and older adults, providing clinical evidence for the potential role of intrarenal RAS activity in the development of CRS.
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Kosaki et al. (2023) conducted a cross-sectional in Cardio-renal syndrome surrogate markers / Chronic kidney disease (n=282). Urinary angiotensinogen (AGT) excretion vs. Lower urinary AGT levels was evaluated on Aortic systolic blood pressure (β 0.219, p=<0.001). Elevated urinary angiotensinogen excretion was independently associated with increased aortic blood pressures, pulsatile measures of renal blood flow, and plasma NT-proBNP levels.
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