The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: Results of the African American study of kidney disease and hypertension

Janice Lea, Tom Greene, Lee Hebert, Michael Lipkowitz, Shaul Massry, John Middleton, Stephen G. Rostand, Edgar Miller, Winifred Smith, George L. Bakris

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The magnitude of proteinuria is associated with a graded increase in the risk of progression to end-stage renal disease and cardiovascular events. The objective of this study was to relate baseline and early changes in proteinuria and glomerular filtration rate (GFR) to long-term progression of hypertensive nondiabetic kidney disease. Methods: Post hoc analysis of a randomized 3 × 2 factorial trial. A total of 1094 African Americans with hypertensive renal disease (GFR, 20-65 mL/min per 1.73 m 2) were followed up for a median of 3.8 years. Participants were randomized to a mean arterial pressure goal of 102 to 107 mm Hg (usual) or 92 mm Hg or less (lower) and to initial treatment with a β-blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ramipril), or a dihydropyridine calcium channel blocker (amlodipine) Results: Baseline proteinuria and GFR predicted the rgate of GFR decline. For each 10-mL/min per 1.73 m 2 lower baseline GFR, an associated mean ± SE 0.38 ± 0.08-mL/ min per 1.73 m 2 per year greater mean GFR decline occurred, and for each 2-fold higher proteinuria level, a mean ± SE 0.54 ± 0.05-mL/min per 1.73 m 2 per year faster GFR decline was observed (P < .001 for both). In multivariate analysis, the effect of baseline proteinuria GFR decline persisted. Initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d. Conclusions: The change in the level of proteinuria is a predictor of subsequent progression of hypertensive kidney disease at a given GFR. A prospective trial is needed to confirm this observation.

Original languageEnglish (US)
Pages (from-to)947-953
Number of pages7
JournalArchives of internal medicine
Volume165
Issue number8
DOIs
StatePublished - Apr 25 2005

ASJC Scopus subject areas

  • Internal Medicine

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