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Kidney Int. 2017 Jan;91(1):196-203. doi: 10.1016/j.kint.2016.09.003. Epub 2016 Oct 28.

Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression.

Author information

1
University of California, San Francisco, San Francisco, California, USA; Kaiser Permanente Northern California, Oakland, California, USA. Electronic address: hsuchi@medicine.ucsf.edu.
2
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
3
Brigham and Women's Hospital, Boston, Massachusetts, USA.
4
Johns Hopkins University, Baltimore, Maryland, USA.
5
Duke University, Durham, North Carolina, USA.
6
Tulane University, New Orleans, Louisiana, USA.
7
University of Illinois, Chicago, Illinois, USA.
8
National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA.
9
University of Michigan, Ann Arbor, Michigan, USA.
10
Case Western Reserve University, Cleveland, Ohio, USA.
11
Yale University, New Haven, Connecticut, USA.
12
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA.
13
Boston University, Boston, Massachusetts, USA.
14
University of California, San Francisco, San Francisco, California, USA.

Abstract

Few investigations have evaluated the incremental usefulness of tubular injury biomarkers for improved prediction of chronic kidney disease (CKD) progression. As such, we measured urinary kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, N-acetyl-ß-D-glucosaminidase and liver fatty acid binding protein under highly standardized conditions among 2466 enrollees of the prospective Chronic Renal Insufficiency Cohort Study. During 9433 person-years of follow-up, there were 581 cases of CKD progression defined as incident end-stage renal disease or halving of the estimated glomerular filtration rate. Levels of the urine injury biomarkers, normalized for urine creatinine, were strongly associated with CKD progression in unadjusted Cox proportional hazard models with hazard ratios in the range of 7 to 15 comparing the highest with the lowest quintiles. However, after controlling for the serum creatinine-based estimated glomerular filtration rate and urinary albumin/creatinine ratio, none of the normalized biomarkers was independently associated with CKD progression. None of the biomarkers improved on the high (0.89) C-statistic for the base clinical model. Thus, among patients with CKD, risk prediction with a clinical model that includes the serum creatinine-based estimated glomerular filtration rate and the urinary albumin/creatinine ratio is not improved on with the addition of renal tubular injury biomarkers.

KEYWORDS:

chronic kidney disease; microalbuminuria; proteinuria

PMID:
28029431
PMCID:
PMC5362331
DOI:
10.1016/j.kint.2016.09.003
[Indexed for MEDLINE]
Free PMC Article

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