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Sci Rep. 2016 May 20;6:26539. doi: 10.1038/srep26539.

Proteinuria as a Therapeutic Target in Advanced Chronic Kidney Disease: a Retrospective Multicenter Cohort Study.

Author information

1
Division of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan.
2
Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
3
Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.
4
Division of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan.
5
Division of Nephrology, Da Chien General Hospital, Miaoli County, Taiwan.
6
Division of Nephrology, Buddhist Tzu Chi Hospital Taipei Branch, New Taipei City, Taiwan.
7
Department of Nephrology, Chi Mei Medical Center, Tainan City, Taiwan.
8
Division of Nephrology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.

Abstract

Current evidence of proteinuria reduction as a surrogate target in advanced chronic kidney disease (CKD) is incomplete due to lack of patient-pooled database. We retrospectively studied a multicenter cohort of 1891 patients who were enrolled in the nationwide multidisciplinary pre-end stage renal disease care program with a baseline glomerular filtration rate (GFR) <45 mL/min/1.73 m(2) and followed longitudinally to investigate the effect of the change in proteinuria on renal death (defined as composite of dialysis and death occurring before initiation of dialysis). The group with a change in proteinuria ≤0.30 g/g (n = 1261) had lower cumulative probabilities of renal death (p < 0.001). In a linear regression model, a higher baseline proteinuria and a greater increase in proteinuria were associated with faster annual GFR decline. Cox's analysis showed that every 1 unit increase in natural log(baseline proteinuria, 10 g/g) and every 0.1 g/g increase in the change in proteinuria resulted in 67% (HR = 1.67, 95% CI: 1.46-1.91) and 1% (HR = 1.01, 95% CI: 1.01-1.01) greater risk of renal death respectively after adjusting for the effects of the other covariates. Our study provided a patient-based evidence to support proteinuria as a therapeutic target in advanced CKD.

PMID:
27198863
PMCID:
PMC4873744
DOI:
10.1038/srep26539
[Indexed for MEDLINE]
Free PMC Article

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