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BMC Nephrol. 2018 Jun 26;19(1):150. doi: 10.1186/s12882-018-0951-0.

Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.

Author information

1
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA. orlandip@pennmedicine.upenn.edu.
2
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. orlandip@pennmedicine.upenn.edu.
3
Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan.
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Guardian Drive, Blockley Hall, Philadelphia, Pennsylvania, 19104-6021, USA.
5
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
6
School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
7
School of Medicine, Wayne State University, Detroit, Michigan, USA.
8
Medicine Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
9
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
10
Cleveland Clinic Foundation, Case Western Reserve University, Cleveland, Ohio, USA.
11
Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
12
John Hopkins University, School of Medicine, Baltimore, Maryland, USA.
13
School of Medicine, University of California, San Francisco, California, USA.
14
National Institutes of Health, Bethesda, Maryland, USA.
15
Renal Division, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, USA.

Abstract

BACKGROUND:

Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study.

METHODS:

Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance.

RESULTS:

Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1: 1.68, Year 2: 1.36), ESRD (Year 1: 1.71, Year 2: 1.39) and death (Year 1:1.92, Year 2: 1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models.

CONCLUSION:

In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction.

KEYWORDS:

CKD; CKD progression; ESRD; Epidemiology; Hematuria; Mortality; Risk factors

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