TY - JOUR
T1 - Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression
AU - CRIC Study Investigators
AU - CKD Biomarkers Consortium
AU - Hsu, Chi yuan
AU - Xie, Dawei
AU - Waikar, Sushrut S.
AU - Bonventre, Joseph V.
AU - Zhang, Xiaoming
AU - Sabbisetti, Venkata
AU - Mifflin, Theodore E.
AU - Coresh, Josef
AU - Diamantidis, Clarissa J.
AU - He, Jiang
AU - Lora, Claudia M.
AU - Miller, Edgar R.
AU - Nelson, Robert G.
AU - Ojo, Akinlolu O.
AU - Rahman, Mahboob
AU - Schelling, Jeffrey R.
AU - Wilson, Francis P.
AU - Kimmel, Paul L.
AU - Feldman, Harold I.
AU - Vasan, Ramachandran S.
AU - Liu, Kathleen D.
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - Kusek, John W.
AU - Lash, James P.
AU - Rahman, Mahboob
AU - Townsend, Raymond R.
N1 - Publisher Copyright:
© 2016 International Society of Nephrology
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Few investigations have evaluated the incremental usefulness of tubular injury biomarkers for improved prediction of chronic kidney disease (CKD) progression. As such, we measured urinary kidney injury molecule-1, neutrophil gelatinase–associated lipocalin, N-acetyl-ß-D-glucosaminidase and liver fatty acid binding protein under highly standardized conditions among 2466 enrollees of the prospective Chronic Renal Insufficiency Cohort Study. During 9433 person-years of follow-up, there were 581 cases of CKD progression defined as incident end-stage renal disease or halving of the estimated glomerular filtration rate. Levels of the urine injury biomarkers, normalized for urine creatinine, were strongly associated with CKD progression in unadjusted Cox proportional hazard models with hazard ratios in the range of 7 to 15 comparing the highest with the lowest quintiles. However, after controlling for the serum creatinine–based estimated glomerular filtration rate and urinary albumin/creatinine ratio, none of the normalized biomarkers was independently associated with CKD progression. None of the biomarkers improved on the high (0.89) C-statistic for the base clinical model. Thus, among patients with CKD, risk prediction with a clinical model that includes the serum creatinine–based estimated glomerular filtration rate and the urinary albumin/creatinine ratio is not improved on with the addition of renal tubular injury biomarkers.
AB - Few investigations have evaluated the incremental usefulness of tubular injury biomarkers for improved prediction of chronic kidney disease (CKD) progression. As such, we measured urinary kidney injury molecule-1, neutrophil gelatinase–associated lipocalin, N-acetyl-ß-D-glucosaminidase and liver fatty acid binding protein under highly standardized conditions among 2466 enrollees of the prospective Chronic Renal Insufficiency Cohort Study. During 9433 person-years of follow-up, there were 581 cases of CKD progression defined as incident end-stage renal disease or halving of the estimated glomerular filtration rate. Levels of the urine injury biomarkers, normalized for urine creatinine, were strongly associated with CKD progression in unadjusted Cox proportional hazard models with hazard ratios in the range of 7 to 15 comparing the highest with the lowest quintiles. However, after controlling for the serum creatinine–based estimated glomerular filtration rate and urinary albumin/creatinine ratio, none of the normalized biomarkers was independently associated with CKD progression. None of the biomarkers improved on the high (0.89) C-statistic for the base clinical model. Thus, among patients with CKD, risk prediction with a clinical model that includes the serum creatinine–based estimated glomerular filtration rate and the urinary albumin/creatinine ratio is not improved on with the addition of renal tubular injury biomarkers.
KW - chronic kidney disease
KW - microalbuminuria
KW - proteinuria
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U2 - 10.1016/j.kint.2016.09.003
DO - 10.1016/j.kint.2016.09.003
M3 - Article
C2 - 28029431
AN - SCOPUS:85005965748
SN - 0085-2538
VL - 91
SP - 196
EP - 203
JO - Kidney international
JF - Kidney international
IS - 1
ER -