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Clin J Am Soc Nephrol. 2013 Jan;8(1):75-81. doi: 10.2215/CJN.03340412. Epub 2012 Oct 18.

Interaction between GFR and risk factors for morbidity and mortality in African Americans with CKD.

Author information

1
Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94304, USA. kevine1@stanford.edu

Abstract

BACKGROUND AND OBJECTIVES:

The African American Study of Kidney Disease Trial identified risk factors for CKD progression and suggested that GFR level may modify the association between these risk factors and CKD progression or death.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Enrollment in the African American Study of Kidney Disease Trial occurred between June of 1995 and September of 2001, with median follow-up of 48.6 months. Among 1094 patients with hypertensive kidney disease in the trial, this study tested whether the association between six previously identified risk factors for CKD progression (or death) and a composite clinical outcome (progression of CKD, ESRD, or death) depends on level of GFR. Multivariate Cox regression was used to control for other baseline risk factors.

RESULTS:

After controlling for baseline risk factors, only proteinuria was more closely associated with the composite clinical outcome at lower levels of GFR (P value for interaction term=0.002); increased hazards of the clinical composite outcome associated with a doubling of proteinuria ranged from 30% (95% confidence interval=21%-39%) with a GFR of 50 to 55% (95% confidence interval=40%-72%) with a GFR of 25.

CONCLUSIONS:

The magnitude of the association between proteinuria and CKD progression, ESRD, or death in the African American Study of Kidney Disease Trial cohort depends on the level of GFR; proteinuria is a stronger independent predictor of the composite clinical outcome at lower levels of GFR. This finding reinforces that African Americans with proteinuria and lower GFR represent a population at particularly high risk for adverse outcomes.

PMID:
23085727
PMCID:
PMC3531654
DOI:
10.2215/CJN.03340412
[Indexed for MEDLINE]
Free PMC Article
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