POS-451 PROTEINURIA ≥ 10G/DAY AS A PROGNOSTIC FACTOR FOR GENERAL AND RENAL SURVIVAL IN PATIENTS WITH NEPHROTIC SYNDROME IN A PERUVIAN HOSPITAL

Abstract

Chronic Kidney Disease (CKD) is a major health problem around the world. In Peru, it is considered to be among the first ten death causes during 2012, representing 3.3% of national deceases. In healthy adults, normal excretion of protein through urine (proteinuria) is less than 150 mg/day. However, values of proteinuria higher than 150 mg/day are considered to be pathological; furthermore, values higher than 3.5 g/day are denominated as nephrotic range proteinuria. In addition, it has been described that proteinuria values higher than 10 g/day, also called malignant proteinuria, has been related to higher CKD incidence and progression. The objective of this study was to compare the renal survival and the mortality among patients with proteinuria ≥ 10 g/day and patients with proteinuria between ≥ 3.5 g/day and < 10 g/day. A retrospective cohort study was accomplished. The exposed population was constituted by patients with proteinuria ≥ 10 g/day and the unexposed one by patients with proteinuria between ≥ 3.5 g/day and < 10 g/day. All patients enrolled were ≥ 18 years old, and the follow up of the population started up with the first proteinuria registered in the clinic history.Sample size was calculated through EPIDAT program, considering statistical significance level (α level) to be 0.05 (5%), β error to be 0.20 (20%) and study potency to be 0.80 (80%). For data collection, a collection form was used in order to register the variables. With this information, a database was created using Microsoft Excel 2018. At last, data was analyzed using STATA version 2015 software. A survival analysis with Cox Regression was performed to assess if proteinuria is an independent predictor of renal survival and mortality. 201 patients were selected, 94 were assigned to the exposed population and 107 to the unexposed one. Nephrotic syndrome etiology from both cohorts were equivalent; but some clinic, demographic and treatment characteristics were not. The mean age was 50.99 ± 16.06 (18-88) years old and 208 were men (53.73%). The principal CKD etiology was diabetes mellitus type II, constituted by 94 patients (46.77%). Diabetic etiology [HR: 2.82 (1.10 – 7.20)], prescription of calcium channel blockers [HR: 1.37 (1.15 – 2.07) p: 0.007], prescription of diuretic agents [HR: 1.39 (1.15 – 2.18) p:0.011] and no prescription of angiotensin II receptor blockers (ARBs) were considered factors related to bad prognosis. Only high values of Glomerular Filtration Rate (GFR) that were measured in the first consultation were consider a protective factor for the renal survival [HR: 0.94 (0.92 – 0.97) p:0.000]. Results did not show renal survival difference between both groups, even though confounding variables were excluded using Cox Regression [HR:1.54 (0.73 – 3.25) p:0.252]. The mortality rate was 0.005% and only 01 deceased was reported. Proteinuria values between ≥ 3.5 g/day to <10 g/day and ≥ 10 g/day were not independently related to renal survival nor mortality in this study. Thus, other variables were related to renal survival such as diabetic etiology, no prescription of ARBs, prescription of diuretic agents and calcium channel blockers, which were considered factors related to bad prognosis. On the other hand, a high value measured of GFR at the hospital admission was consider a protective factor.