Changes in albuminuria, eGFR linked with risk of advanced CKD
Increases in urinary albumin-creatinine ratio and decreases in estimated glomerular filtration rate heighten the risk for advanced chronic kidney disease, according to a study.
“Changes in estimated glomerular filtration rate and albuminuria (UACR) have both been used individually as alternative outcomes in kidney trials,” Brendon L. Neuen, MBBS, MSc, of the George Institute for Global Health and University of New South Wales, and authors wrote. “However, there has been little consideration of the utility of combining change in albuminuria and change in eGFR as a surrogate for progression to kidney failure.”
In this large, general population, observational cohort study, the researchers investigated the predictive possibilities of combined changes in UACR and eGFR for advanced kidney disease. Using the U.K. Clinical Practice Research Datalink, Neuen and colleagues studied 91,319 patients with spot UACR and eGFR measurements about 3 years apart between 2000 and 2015. Participants were between 20 and 75 years old and had at least 1 year of preceding data from their primary care practice at the time of the first UACR measurement. Primary outcome involved an advanced CKD diagnosis (sustained eGFR <30 mL/min/1.73 m ²). Patients with advanced CKD at baseline were excluded. Researchers measured eGFR for at least 90 days using the Chronic Kidney Disease Epidemiology Collaboration equation. They defined the exposure window as the period between the first and second UACR/eGFR measurements; the study involved an average exposure of 3 years.
Greater increases in UACR presented more often in older patients with a lower baseline eGFR and UACR, a history of cardiovascular disease and greater use of renin-angiotensin system (RAS) blockade and other antihypertensive medications. Patients with greater decreases in eGFR were also older, with higher baseline UACR and blood pressure, usually a history of CVD, and greater use of RAS blockade and other antihypertensive medications.
The mean eGFR among all patients was 72.6 mL/min/1.73 m² and the median UACR was 9.7 mg/g. After a mean follow-up of 2.9 years, 2,541 patients had advanced CKD. Researchers found that observing a combination of changes in UACR and eGFR had better predication abilities for kidney outcomes.
“Compared to participants with stable UACR and eGFR values, a combined increase in UACR and decrease in eGFR was associated with increased risk of kidney, cardiovascular and mortality outcomes, although the magnitude of the association was largest for kidney outcomes,” Neuen and colleagues wrote.
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