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Clin J Am Soc Nephrol. 2018 Jul 6;13(7):1013-1021. doi: 10.2215/CJN.13631217. Epub 2018 Jun 14.

Soluble Urokinase-Type Plasminogen Activator Receptor in Black Americans with CKD.

Author information

1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
2
Welch Center for Prevention, Epidemiology, and Clinical Research.
3
Division of General Internal Medicine, Department of Medicine, and.
4
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
5
Division of Cardiology, Emory University, Atlanta, Georgia.
6
Division of Cardiology and.
7
Division of Nephrology, Georgetown University, Washington, DC; and.
8
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
9
Department of Medicine, Rush University Medical Center, Chicago, Illinois.
10
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; mgrams2@jhmi.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Black Americans with and without APOL1 kidney disease risk variants face high risk of ESKD. Soluble urokinase-type plasminogen activator receptor (suPAR), a circulating signaling protein and marker of immune activation, constitutes a promising biomarker of CKD-associated risks. We aimed to quantify the associations between serum suPAR concentration and adverse outcomes in Black Americans with and without APOL1 kidney disease risk variants, over and above iodine-125 iothalamate measured GFR and proteinuria.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Using data from the African-American Study of Kidney Disease and Hypertension, a multicenter clinical trial followed by a cohort phase with a median total follow-up of 9.7 years (interquartile range, 6.5-10.9 years), we examined the associations of suPAR with CKD progression (defined as doubling of serum creatinine or ESKD), ESKD, worsening proteinuria (defined as pre-ESKD doubling of 24-hour urine protein-to-creatinine ratio to ≥220 mg/g), and all-cause death.

RESULTS:

At baseline, the median suPAR was 4462 pg/ml, mean measured GFR was 46 ml/min per 1.73 m2, and median 24-hour urine protein-to-creatinine ratio was 80 mg/g. After controlling for baseline demographics, randomization arm, GFR, proteinuria, APOL1 risk status, and clinical risk factors, there was a 1.26-times higher risk for CKD progression per SD higher baseline log-transformed suPAR (hazard ratio [HR], 1.26; 95% confidence interval [95% CI], 1.11 to 1.43; P<0.001). Higher suPAR was also independently associated with risk of ESKD (HR, 1.36; 95% CI, 1.17 to 1.58; P<0.001) and death (HR, 1.25; 95% CI, 1.08 to 1.45; P=0.003). suPAR was only associated with worsening proteinuria in patients with two APOLI risk alleles (HR, 1.46; 95% CI, 1.08 to 1.99; P=0.02).

CONCLUSIONS:

Higher suPAR was associated with various adverse outcomes in Black Americans with CKD, with and without APOL1 kidney disease risk variants, independently of proteinuria and GFR.

KEYWORDS:

African Americans; Alleles; Biomarkers; Black Americans; Demography; Follow-Up Studies; Humans; Iothalamic Acid; Kidney Failure, Chronic; Random Allocation; Receptors, Urokinase Plasminogen Activator; Renal Insufficiency, Chronic; United States; chronic kidney disease; creatinine; glomerular filtration rate; hypertension; kidney; proteinuria; risk factors

PMID:
29903900
PMCID:
PMC6032570
[Available on 2019-07-06]
DOI:
10.2215/CJN.13631217

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