Patients with CKD and normoalbuminuria may have higher risk for disease progression
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Key takeaways:
- Researchers aimed to estimate the increase in cumulative incidence of chronic kidney disease.
- During a median 9.8 years follow-up, 182 patients had CKD progression.
Patients with chronic kidney disease and normoalbuminuria had higher risk for disease progression that increased in a linearly relationship with higher albuminuria levels, according to data.
“Measurement of albuminuria is an essential method to identify persons with undiagnosed chronic kidney disease (CKD),” Ashish Verma, MB, BS, of the section of nephrology at Boston Medical Center, Boston University, wrote with colleagues. However, “few studies have evaluated the risk gradient for CKD progression in persons with CKD and albuminuria less than 30 mg/g. Enhanced understanding of the risks associated with higher levels of albuminuria in the normoalbuminuric range may help change clinical thresholds ... ”
Researchers conducted a multicenter prospective cohort study at seven U.S. clinical centers, which included 1,629 patients with CKD, defined as an eGFR between 20 mL/min/1.73 m2 and 70 mL/min/1.73 m2 and a urine albumin-creatinine ratio (UACR) of less than 30 mg/g.
Using UACR as the exposure variable, the study measured 10-year adjusted cumulative incidences of CKD progression, defined as a composite of 50% eGFR decline or the need for kidney failure interventions, such as dialysis or transplantation.
The goal of the study was to estimate the increase in cumulative incidence of CKD progression with greater baseline levels of albuminuria in patients with CKD and normoalbuminuria.
During a median 9.8 years follow-up, 182 patients had CKD progression, according to the results. The 10-year adjusted cumulative incidences of CKD progression were 8.7%, 11.5% and 19.5% for UACR levels between 0 mg/g and less than 5 mg/g; 5 mg/g to less than 15 mg/g; and 15 mg/g or more, respectively, data showed.
Verma and colleagues also noted that the absolute risk differences were 7.9% and 10.7%, respectively, when comparing patients with UACR levels of 15 mg/g or more to patients with UACR of 5 mg/g to less than 15 mg/g and to those with UACR of 0 mg/g to less than 5 mg/g.
“These findings underscore the need for future studies to determine the optimal threshold for initiating treatment with antiproteinuric agents and whether the further reduction in albuminuria may improve adverse clinical outcomes in persons with CKD who have normoalbuminuria,” the researchers wrote.
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