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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

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


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.

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