Abstract
Current evidence of proteinuria reduction as a surrogate target in advanced chronic kidney disease (CKD) is incomplete due to lack of patient-pooled database. We retrospectively studied a multicenter cohort of 1891 patients who were enrolled in the nationwide multidisciplinary pre-end stage renal disease care program with a baseline glomerular filtration rate (GFR) <45 mL/min/1.73 m2 and followed longitudinally to investigate the effect of the change in proteinuria on renal death (defined as composite of dialysis and death occurring before initiation of dialysis). The group with a change in proteinuria ≤0.30 g/g (n = 1261) had lower cumulative probabilities of renal death (p < 0.001). In a linear regression model, a higher baseline proteinuria and a greater increase in proteinuria were associated with faster annual GFR decline. Cox’s analysis showed that every 1 unit increase in natural log(baseline proteinuria, 10 g/g) and every 0.1 g/g increase in the change in proteinuria resulted in 67% (HR = 1.67, 95% CI: 1.46–1.91) and 1% (HR = 1.01, 95% CI: 1.01–1.01) greater risk of renal death respectively after adjusting for the effects of the other covariates. Our study provided a patient-based evidence to support proteinuria as a therapeutic target in advanced CKD.
Highlights
Since 2002, the publication of a clinical practice guideline on CKD7 by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) has generated immense effects on research, clinical practice, and public health policy
By using generalized additive models (GAM), patients were stratified into a high proteinuria group and a low proteinuria group (Fig. 2a and Table 1)
In this study of an advanced chronic kidney disease (CKD) population, we demonstrated that high baseline proteinuria (UPCR >1 .04 g/g) was associated with rapid glomerular filtration rate (GFR) decline and predicted renal death
Summary
Since 2002, the publication of a clinical practice guideline on CKD7 by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) has generated immense effects on research, clinical practice, and public health policy. The program has been proven to be helpful in reducing the incidence of ESRD, mortality, and medical costs by means of a more effective diet and medical control according to the NKF KDOQI guidelines[4,8,9]. Evidences showed that multimodal regimen targeting at proteinuria reduction could effectively retard the progression of CKD20,21. Proteinuria has been advocated as a potential target for treatment in CKD22–24. By using a large population of patients with advanced CKD with multihospital collaboration in Taiwan, the present study investigated the hypothesis that proteinuria reduction benefits renal outcomes
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