Abstract
BackgroundInflammation plays a pivotal role in the pathogenesis of chronic kidney disease (CKD). Significant association between serum albumin-to-globulin (AG) ratio and inflammation led us to investigate the prognostic value of serum AG ratio for incident CKD.MethodsThe predictive value of serum AG ratio, white blood cell (WBC), and C-reactive protein (CRP) for CKD development was assessed in 8,057 non-CKD participants from a community-based, prospective cohort in Korea. Serum AG ratio was calculated by following equation: serum albumin (g/L)/[serum total protein (g/L)-serum albumin (g/L)]. Incident CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or proteinuria of more than 1+ on dipstick.ResultsMedian serum AG ratio was 1.38 (interquartile range, 1.28–1.52). During a mean follow-up duration of 9.1±3.7 years, 1,732 participants (21.5%) developed CKD. In a multivariable Cox analysis, a low serum AG ratio was significantly associated with an increased risk of incident CKD (Q1, serum AG ratio <1.26: hazard ratio [HR] = 1.651, 95% confidence interval [CI] = 1.406–1.938, Q5 as reference; per 0.2 decrease, HR = 1.170, 95% CI = 1.109–1.234). Serum AG ratio was the only indicator to improve the predictability of CKD development (net reclassification index = 0.158, P <0.001; integrated discrimination improvement = 0.005, P <0.001), compared with WBC or CRP.ConclusionsThis study demonstrates that low serum AG ratio is an independent predictor for CKD development and exhibits a stronger predictive value than other inflammatory markers. These findings suggest that determining serum AG ratio may be more valuable for predicting adverse kidney outcomes in non-CKD populations.
Highlights
The increasing incidence and prevalence of chronic kidney disease (CKD) had led to its global recognition as a preeminent public health problem [1]
In a multivariable Cox analysis, a low serum AG ratio was significantly associated with an increased risk of incident CKD (Q1, serum AG ratio
Serum AG ratio was the only indicator to improve the predictability of CKD development, compared with white blood cell (WBC) or C-reactive protein (CRP)
Summary
The predictive value of serum AG ratio, white blood cell (WBC), and C-reactive protein (CRP) for CKD development was assessed in 8,057 non-CKD participants from a community-based, prospective cohort in Korea. Serum AG ratio was calculated by following equation: serum albumin (g/L)/[serum total protein (g/L)-serum albumin (g/L)]. Data Availability Statement: Data underlying the results presented in this study are owned by a third-party organization (The Korean Genome and Epidemiology Study-Ansan and Ansung study, KoGES; 4851-302). The authors did not have any special access to this data that other researchers would not have. Data are available by online sharing service under the permission of the Division of Epidemiology and Health Index of the Korean Center for Disease Control and Prevention (KCDC). Researchers can request to access the data via E-mail (whalwls0227@korea.kr) or website
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