TY - JOUR
T1 - Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality
AU - Carrero, Juan Jesús
AU - Grams, Morgan E.
AU - Sang, Yingying
AU - Ärnlöv, Johan
AU - Gasparini, Alessandro
AU - Matsushita, Kunihiro
AU - Qureshi, Abdul R.
AU - Evans, Marie
AU - Barany, Peter
AU - Lindholm, Bengt
AU - Ballew, Shoshana H.
AU - Levey, Andrew S.
AU - Gansevoort, Ron T.
AU - Elinder, Carl G.
AU - Coresh, Josef
N1 - Publisher Copyright:
© 2016 International Society of Nephrology
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Current guidelines for chronic kidney disease (CKD) recommend using albuminuria as well as estimated glomerular filtration rate (eGFR) to stage CKD. However, CKD progression is solely defined by change in eGFR with little regard to the risk implications of change in albuminuria. This is an observational study from the Stockholm CREAtinine Measurements (SCREAM) project, a health care utilization cohort from Stockholm, Sweden, with laboratory measures from 2006–2011 and follow-up through December 2012. Included were 31,732 individuals with two or more ambulatory urine albumin to creatinine ratio (ACR) tests. We assessed the association between change in ACR during a baseline period of 1, 2, or 3 years and end-stage renal disease (ESRD) or death. Using a 2-year baseline period, there were 378 ESRD events and 1712 deaths during a median of 3 years of follow-up. Compared to stable ACR, a 4-fold increase in ACR was associated with a 3.08-times (95% confidence interval 2.59 to 3.67) higher risk of ESRD while a 4-fold decrease in ACR was associated with a 0.34-times (0.26 to 0.45) lower risk of ESRD. Similar associations were found in people with and without diabetes mellitus, with and without hypertension, and also when adjusted for the change in eGFR during the same period. The association between change in ACR and mortality was weaker: ACR increase was associated with mortality, but the relationship was largely flat for ACR decline. Results were consistent for 1-, 2-, and 3-year ACR changes. Thus, changes in albuminuria are strongly and consistently associated with the risk of ESRD and death.
AB - Current guidelines for chronic kidney disease (CKD) recommend using albuminuria as well as estimated glomerular filtration rate (eGFR) to stage CKD. However, CKD progression is solely defined by change in eGFR with little regard to the risk implications of change in albuminuria. This is an observational study from the Stockholm CREAtinine Measurements (SCREAM) project, a health care utilization cohort from Stockholm, Sweden, with laboratory measures from 2006–2011 and follow-up through December 2012. Included were 31,732 individuals with two or more ambulatory urine albumin to creatinine ratio (ACR) tests. We assessed the association between change in ACR during a baseline period of 1, 2, or 3 years and end-stage renal disease (ESRD) or death. Using a 2-year baseline period, there were 378 ESRD events and 1712 deaths during a median of 3 years of follow-up. Compared to stable ACR, a 4-fold increase in ACR was associated with a 3.08-times (95% confidence interval 2.59 to 3.67) higher risk of ESRD while a 4-fold decrease in ACR was associated with a 0.34-times (0.26 to 0.45) lower risk of ESRD. Similar associations were found in people with and without diabetes mellitus, with and without hypertension, and also when adjusted for the change in eGFR during the same period. The association between change in ACR and mortality was weaker: ACR increase was associated with mortality, but the relationship was largely flat for ACR decline. Results were consistent for 1-, 2-, and 3-year ACR changes. Thus, changes in albuminuria are strongly and consistently associated with the risk of ESRD and death.
KW - albuminuria
KW - changes in albuminuria
KW - death
KW - end-stage renal disease
KW - estimated glomerular filtration rate
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U2 - 10.1016/j.kint.2016.09.037
DO - 10.1016/j.kint.2016.09.037
M3 - Article
C2 - 27927597
AN - SCOPUS:85006515702
SN - 0085-2538
VL - 91
SP - 244
EP - 251
JO - Kidney international
JF - Kidney international
IS - 1
ER -