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Publications

Journal Article Ahead of print

PubMed: 42658641 DOI: 10.2215/CJN.0000001206

Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD: Insights from CRIC and KNOW-CKD Studies.

Clin J Am Soc Nephrol

Authors: Cheol Ho Park, Hyun Jun Hong, Hyung Woo Kim, Jung Tak Park, Tae Ik Chang, Tae-Hyun Yoo, Sue K Park, Jung Soon Kim, Kyu-Beck Lee, Jong Cheol Jeong, Kook-Hwan Oh, Amanda H Anderson, Wei Yang, Jordana B Cohen, Mahboob Rahman, Shin-Wook Kang, Seung Hyeok Han

Affiliations

  • Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea. Yonsei Institute for Digital Healthcare, Yonsei University, Seoul, Republic of Korea.
  • Yonsei University, College of Medicine, Seoul, Republic of Korea.
  • Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
  • Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Republic of Korea.
  • Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Cancer Research Institute, Seoul National University, Seoul, Republic of Korea. Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • Department of Internal Medicine, Eulji General Hospital, Seoul, Republic of Korea.
  • Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
  • Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.
  • Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
  • Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.

Abstract

INTRODUCTION

While urine protein-to-creatinine ratio (UPCR) is more commonly used than urine albumin-to-creatinine ratio in routine care, and particularly in low-resource settings; its association with kidney function decline and projected time to reach a kidney failure estimated glomerular filtration rate (eGFR) threshold in advanced chronic kidney disease (CKD) remains underexplored.

METHODS

We analyzed 2,727 participants with eGFR 15-45mL/min/1.73 m2 without kidney replacement therapy (KRT) from the Chronic Renal Insufficiency Cohort (CRIC) study and the KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD). The main exposures were baseline and time-updated UPCR. The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of KRT. The secondary outcome was eGFR slope (mL/min/1.73 m2/year), whereas the exploratory outcome was projected time to reach the eGFR threshold of 10 mL/min/1.73 m2 for kidney failure.

RESULTS

During 17,069 person-years of follow-up (median 4.9 years), the primary outcome occurred in 1,474 participants (54%). Compared with UPCR <0.5 g/gCr, hazard ratios (HRs) (95% confidence intervals [CIs]) for UPCR categories of 0.5-1.0, 1.0-3.0, and ≥ 3.0 g/gCr were 2.08 (1.76-2.45), 3.05 (2.64-3.52), and 6.32 (5.24-7.61), respectively. This association was stronger in analysis with time-updated UPCR, with the corresponding HRs (95% CIs) of 2.58 (2.13-3.12), 5.61 (4.76-6.62), and 12.88 (10.58-15.67), respectively. In secondary analyses, the eGFR slopes for the respective categories were -0.87 (-0.98 to -0.77), -2.32 (-2.56 to -2.07), -3.41 (-3.63 to -3.19), and -5.45 (-5.93 to -4.97) mL/min/1.73 m2 per year. Additionally, projected time to eGFR threshold for kidney failure (95% CIs) was lower progressively with increasing proteinuria categories, estimated at 28.7 (25.6-32.6), 10.3 (9.3-11.5), 6.4 (6.0-6.8), and 3.8 (3.5-4.2) years, respectively.

CONCLUSIONS

Higher UPCR levels were strongly associated with accelerated CKD progression and shorter projected time to reach the eGFR threshold for kidney failure, underscoring the prognostic significance of proteinuria in patients with advanced CKD.

MeSH

Kidney Diseases, Proteinuria, Creatinine, Kidney, Nephrology