Background.In non-dialysis chronic kidney disease (CKD), ab-solute proteinuria (Uprot) depends on the extent of kidneydamage and residual glomerular filtration rate (GFR). Wetherefore evaluated, as compared with Uprot, the strength of as-sociation of proteinuria indexed to estimated GFR (eGFR) withend-stage renal disease (ESRD) risk.Methods.In a multi-cohort prospective study in 3957 CKDpatients of Stages G3–G5 referred to nephrology clinics, wetested two multivariable Cox models for ESRD risk, with either Uprot (g/24 h) or filtration-adjusted proteinuria (F-Uprot) cal-culated as Uprot/eGFR100.Results.Mean6SD age was 67614 years, males 60%, dia-betics 29%, cardiovascular disease (CVD) 34%, eGFR32613 mL/min/1.73 m2, median (interquartile range) Uprot0.41 (0.12–1.29) g/24 h and F-Uprot 1.41 (0.36–4.93) g/24 h per100 mL/min/1.73 m2eGFR. Over a median follow-up of44 months, 862 patients reached ESRD. At competing riskanalysis, ESRD risk progressively increased when F-Uprot was1.0–4.9 and5.0 versus<1.0 g/24 h per 100 mL/min/1.73 m2eGFR in Stages G3a–G4 (P<0.001) and Stage G5 (P¼0.002). Multivariable Cox analysis showed that Uprot predicts ESRD inStages G3a–G4 while in G5 the effect was not significant; con-versely, F-Uprot significantly predicted ESRD at all stages. TheF-Uprot model allowed a significantly better prediction versusthe Uprot model according to Akaike information criterion.Net reclassification improvement was 12.2% (95% confidenceinterval 4.2–21.1), with higher reclassification in elderly, diabe-tes and CVD, as well as in diabetic nephropathy and glomerulo-nephritis, and in CKD Stages G4 and G5.Conclusions.In patients referred to nephrology clinics,F-Uprot predicts ESRD at all stages of overt CKD and improves,as compared with Uprot, reclassification of patients for renalrisk, especially in more advanced and complicated disease.
Reclassification of chronic kidney disease patients for end-stagerenal disease risk by proteinuria indexed to estimated glomerular filtration rate: multicentre prospective study in nephrology clinics / Provenzano, Michele; Chiodini, Paolo; Minutolo, Roberto; Zoccali, Carmine; Bellizzi, Vincenzo; Conte, Giuseppe; Locatelli, Francesco; Tripepi, Giovanni; Del Vecchio, Lucia; Mallamaci3Lucia Di Micco, Francesca; Russo, Domenico; Heerspink, Hiddo L.; De Nicola, Luca. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - 35:(2020), pp. 138-147. [10.1093/ndt/gfy217]
Reclassification of chronic kidney disease patients for end-stagerenal disease risk by proteinuria indexed to estimated glomerular filtration rate: multicentre prospective study in nephrology clinics
Domenico Russo;
2020
Abstract
Background.In non-dialysis chronic kidney disease (CKD), ab-solute proteinuria (Uprot) depends on the extent of kidneydamage and residual glomerular filtration rate (GFR). Wetherefore evaluated, as compared with Uprot, the strength of as-sociation of proteinuria indexed to estimated GFR (eGFR) withend-stage renal disease (ESRD) risk.Methods.In a multi-cohort prospective study in 3957 CKDpatients of Stages G3–G5 referred to nephrology clinics, wetested two multivariable Cox models for ESRD risk, with either Uprot (g/24 h) or filtration-adjusted proteinuria (F-Uprot) cal-culated as Uprot/eGFR100.Results.Mean6SD age was 67614 years, males 60%, dia-betics 29%, cardiovascular disease (CVD) 34%, eGFR32613 mL/min/1.73 m2, median (interquartile range) Uprot0.41 (0.12–1.29) g/24 h and F-Uprot 1.41 (0.36–4.93) g/24 h per100 mL/min/1.73 m2eGFR. Over a median follow-up of44 months, 862 patients reached ESRD. At competing riskanalysis, ESRD risk progressively increased when F-Uprot was1.0–4.9 and5.0 versus<1.0 g/24 h per 100 mL/min/1.73 m2eGFR in Stages G3a–G4 (P<0.001) and Stage G5 (P¼0.002). Multivariable Cox analysis showed that Uprot predicts ESRD inStages G3a–G4 while in G5 the effect was not significant; con-versely, F-Uprot significantly predicted ESRD at all stages. TheF-Uprot model allowed a significantly better prediction versusthe Uprot model according to Akaike information criterion.Net reclassification improvement was 12.2% (95% confidenceinterval 4.2–21.1), with higher reclassification in elderly, diabe-tes and CVD, as well as in diabetic nephropathy and glomerulo-nephritis, and in CKD Stages G4 and G5.Conclusions.In patients referred to nephrology clinics,F-Uprot predicts ESRD at all stages of overt CKD and improves,as compared with Uprot, reclassification of patients for renalrisk, especially in more advanced and complicated disease.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
