Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality

Juan Jesús Carrero, Morgan E. Grams, Yingying Sang, Johan Ärnlöv, Alessandro Gasparini, Kunihiro Matsushita, Abdul R. Qureshi, Marie Evans, Peter Barany, Bengt Lindholm, Shoshana H. Ballew, Andrew S. Levey, Ron T. Gansevoort, Carl G. Elinder, Josef Coresh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)244-251
Number of pages8
JournalKidney International
Volume91
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Albuminuria
Chronic Kidney Failure
Creatinine
Mortality
Albumins
Glomerular Filtration Rate
Chronic Renal Insufficiency
Patient Acceptance of Health Care
Sweden
Observational Study
Disease Progression
Diabetes Mellitus
Urine
Confidence Intervals
Hypertension

Keywords

  • albuminuria
  • changes in albuminuria
  • death
  • end-stage renal disease
  • estimated glomerular filtration rate

ASJC Scopus subject areas

  • Medicine(all)
  • Nephrology

Cite this

Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality. / Carrero, Juan Jesús; Grams, Morgan E.; Sang, Yingying; Ärnlöv, Johan; Gasparini, Alessandro; Matsushita, Kunihiro; Qureshi, Abdul R.; Evans, Marie; Barany, Peter; Lindholm, Bengt; Ballew, Shoshana H.; Levey, Andrew S.; Gansevoort, Ron T.; Elinder, Carl G.; Coresh, Josef.

In: Kidney International, Vol. 91, No. 1, 01.01.2017, p. 244-251.

Research output: Contribution to journalArticle

Carrero, JJ, Grams, ME, Sang, Y, Ärnlöv, J, Gasparini, A, Matsushita, K, Qureshi, AR, Evans, M, Barany, P, Lindholm, B, Ballew, SH, Levey, AS, Gansevoort, RT, Elinder, CG & Coresh, J 2017, 'Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality' Kidney International, vol 91, no. 1, pp. 244-251. DOI: 10.1016/j.kint.2016.09.037

Carrero, Juan Jesús; Grams, Morgan E.; Sang, Yingying; Ärnlöv, Johan; Gasparini, Alessandro; Matsushita, Kunihiro; Qureshi, Abdul R.; Evans, Marie; Barany, Peter; Lindholm, Bengt; Ballew, Shoshana H.; Levey, Andrew S.; Gansevoort, Ron T.; Elinder, Carl G.; Coresh, Josef / Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality.

In: Kidney International, Vol. 91, No. 1, 01.01.2017, p. 244-251.

Research output: Contribution to journalArticle

@article{856a8155b94b45b096b164ce03276d53,
title = "Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality",
abstract = "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.",
keywords = "albuminuria, changes in albuminuria, death, end-stage renal disease, estimated glomerular filtration rate",
author = "Carrero, {Juan Jesús} and Grams, {Morgan E.} and Yingying Sang and Johan Ärnlöv and Alessandro Gasparini and Kunihiro Matsushita and Qureshi, {Abdul R.} and Marie Evans and Peter Barany and Bengt Lindholm and Ballew, {Shoshana H.} and Levey, {Andrew S.} and Gansevoort, {Ron T.} and Elinder, {Carl G.} and Josef Coresh",
year = "2017",
month = "1",
doi = "10.1016/j.kint.2016.09.037",
volume = "91",
pages = "244--251",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "1",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=85006515702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006515702&partnerID=8YFLogxK

U2 - 10.1016/j.kint.2016.09.037

DO - 10.1016/j.kint.2016.09.037

M3 - Article

VL - 91

SP - 244

EP - 251

JO - Kidney International

T2 - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 1

ER -