Assessment of stress & related albuminuria in caregivers of severe mentally ill persons.

BACKGROUND & OBJECTIVES: The family caregivers of patients with chronic diseases are known to undergo psychiatric stress leading to oxidative damage to glomerular membrane of kidney resulting in proteinuria. This study was aimed to compare current anxiety, depression levels and urinary albumin:creatinine ratio between primary caregivers of chronic mental patients and matched controls, and also whether the urinary albumin : creatinine ratio is correlated with stress factors (state and trait anxiety level, depression and caregiver burden) amongst caregivers. METHODS: The present cross-sectional study included 131 subjects (93 primary caregivers of patients with major mental illness as cases and 38 normal controls). They completed the Burden Assessment Schedule of SCARF, State Trait Anxiety Inventory and Beck's Depression Inventory. A spot urine sample was tested for urinary albumin : creatinine ratio from all study subjects. RESULTS: Mean values of current State and Trait anxiety, depression, urinary albumin:creatinine ratio were significantly higher in caregivers than controls (P < 0.001). Urinary albumin : creatinine ratio was significantly correlated (P < 0.001) with State and Trait anxiety level, depression as well as caregiver burden. INTERPRETATION & CONCLUSIONS: The study demonstrated depression , anxiety and albuminuria amongst primary caregivers of patients with mental illness. Increase in the caregivers' burden, depression and anxiety resulted in an increase in the urinary albumin: creatinine ratio. This indicates that psychological stress is one of the determinants of albumin excretion rate in otherwise healthy subjects.

Assessment of patients' and physicians' compliance to an ACE inhibitor treatment based on urinary N-acetyl Ser-Asp-Lys-Pro determination in the Noninsulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) study.

OBJECTIVE: The purpose of this study was to assess patients' and physicians' compliance with ACE inhibitor treatment, by measuring an endogenous biomarker of ACE inhibition, urinary N-acetyl-Ser-Asp-Lys-Pro (AcSDKP), in the Noninsulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial, which compared ramipril (1.25 mg o.d.) with placebo in 4,912 patients with type 2 diabetes and microalbuminuria/proteinuria. RESEARCH DESIGN AND METHODS: The urine AcSDKP-to-creatinine ratio was measured blind to treatment in all participants who completed follow-up and provided spot urine samples (n = 1,871). RESULTS: The median urinary AcSDKP-to-creatinine ratio was six times higher for ramipril than for placebo. Urinary AcSDKP-to-creatinine ratios displayed a bimodal distribution in both groups, with a very large intergroup overlap. Based on cluster analysis, we defined truly adherent ramipril patients as those with a ratio > or =4 nmol/mmol and truly adherent placebo patients as those with a ratio < 4 nmol/mmol. After excluding patients withdrawing prematurely from the study or known to have used a nonstudy ACE inhibitor, 27.3% of the 597 ramipril patients had ratios <4, indicating poor compliance, and 9.7% of the 621 placebo patients had ratios > or =4, indicating intake of a nonstudy ACE inhibitor. Correcting for compliance by using AcSDKP-guided analysis affected surrogate outcome results (decrease in systolic blood pressure and urinary albumin excretion) only slightly. CONCLUSIONS: The systematic use of spot urinary AcSDKP determination facilitated the detection of defects in compliance with ACE inhibitor treatment in both patients and physicians. Urinary AcSDKP measurement could be a useful biomarker for assessing compliance with ACE inhibition in the routine care of diabetic patients.