Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression

CRIC Study Investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalKidney International
Volume91
Issue number1
DOIs
StatePublished - Jan 1 2017

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Chronic Renal Insufficiency
Disease Progression
Biomarkers
Urine
Wounds and Injuries
Glomerular Filtration Rate
Creatinine
Albumins
Lipocalins
Kidney
Hexosaminidases
Fatty Acid-Binding Proteins
Serum
Proportional Hazards Models
Chronic Kidney Failure
Neutrophils
Cohort Studies

Keywords

  • chronic kidney disease
  • microalbuminuria
  • proteinuria

ASJC Scopus subject areas

  • Medicine(all)
  • Nephrology

Cite this

Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression. / CRIC Study Investigators.

In: Kidney International, Vol. 91, No. 1, 01.01.2017, p. 196-203.

Research output: Contribution to journalArticle

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abstract = "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.",
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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

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

AU - Feldman, Harold I.

AU - Go, Alan S.

AU - He, Jiang

AU - Kusek, John W.

AU - Lash, James P.

AU - Ojo, Akinlolu

AU - Rahman, Mahboob

AU - Townsend, Raymond R.

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KW - microalbuminuria

KW - proteinuria

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