Hematuria as a risk factor for progression of chronic kidney disease and death: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

Paula F. Orlandi, Naohiko Fujii, Jason Roy, Hsiang Yu Chen, L. Lee Hamm, James H. Sondheimer, Jiang He, Michael J. Fischer, Hernan Rincon-Choles, Geetha Krishnan, Raymond Townsend, Tariq Shafi, Chi Yuan Hsu, John W. Kusek, John T. Daugirdas, Harold I. Feldman, Lawrence J. Appel, Alan S. Go, James P. Lash, Panduranga S. RaoMahboob Rahman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. Methods: Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance. Results: Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1: 1.68, Year 2: 1.36), ESRD (Year 1: 1.71, Year 2: 1.39) and death (Year 1:1.92, Year 2: 1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models. Conclusion: In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction.

Original languageEnglish (US)
Article number150
JournalBMC nephrology
Volume19
Issue number1
DOIs
StatePublished - Jun 26 2018

Keywords

  • CKD
  • CKD progression
  • ESRD
  • Epidemiology
  • Hematuria
  • Mortality
  • Risk factors

ASJC Scopus subject areas

  • Nephrology

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