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Higher proteinuria levels associated with more severe adverse events
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The risks for mortality and adverse outcomes, including MI and progression to kidney failure, associated with lower estimated glomerular filtration rates were independently increased with higher levels of proteinuria, study results suggested.
“Patients with heavy proteinuria but without overtly abnormal estimated glomular filtration rates (GFRs) appeared to have worse clinical outcomes than those with moderately reduced estimated GFRs but without proteinuria,” the researchers wrote.
They examined data from a lab registry in Alberta, Canada, which included 920,985 adults. Patients included in the study did not require renal replacement treatment and had at least one outpatient serum creatinine measurement. The primary outcome measure was all-cause mortality, MI and progression to kidney failure. The researchers performed patient follow-up at a median of 35 months.
Most individuals (89.1%) had an estimated GFR of 60 mL per minute per 1.73 m2 or greater. The researchers reported 27,959 deaths, 5,772 hospitalizations for MI, 771 initiations of renal replacement therapy and 2,514 patients whose creatinine levels doubled during follow-up.
The adjusted mortality risk was more than twofold higher in those with heavy proteinuria and an estimated GFR of 60 mL per minute per 1.73 m2 or greater compared with those who had an estimated GFR of 45 mL to 59.9 mL per minute per 1.73 m2 and normal protein excretion (rate ratio=2.5; 95% CI, 2.3-2.7).
When both heavy and absent proteinuria were measured with albumin–creatinine ratio, the mortality risk results were similar (rate ratio=2.3; 95% CI, 2.0-2.6). Similar rates were reported for the outcomes of hospitalization with acute MI (P<.001), initiation of renal replacement therapy (P<.001) or the doubling of serum creatinine (P<.001).
“These findings suggest that future revisions to the classification system for chronic kidney disease should incorporate information from proteinuria,” the researchers concluded.
Hemmelgarn B. JAMA. 2010;303:423-429.