Takeaway
- The combination of increased urinary albumin-creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) was strongly associated with an increased risk of advanced chronic kidney disease (CKD) and kidney failure.
Why this matters
- Findings warrant assessment of combined changes in UACR/eGFR as an alternative marker for kidney failure in CKD progression trials.
Study design
- An observational cohort study included 91,319 participants (mean eGFR, 72.6 mL/min/1.73m2; median UACR, 9.7 mg/g) from the UK Clinical Practice Research Datalink (CPRD).
- Primary outcome: advanced CKD (sustained eGFR, <30 mL/min/1.73m2).
- Funding: NIHR Biomedical Research Centre, Oxford.
Key results
- During a median follow-up of 2.9 years, 2541 participants progressed to advanced CKD, 379 had kidney failure, 7185 developed cardiovascular disease and 9853 died.
- Compared with stable values:
- ≥30% increase in UACR was associated with an increased risk of (adjusted HR [aHR]; 95% CI):
- advanced CKD (1.78; 1.59-1.98); and
- kidney failure (4.16; 2.74-6.32).
- ≥30% decrease in eGFR was associated with an increased risk of (aHR; 95% CI):
- advanced CKD (7.53; 6.70-8.45); and
- kidney failure (5.09; 3.27-7.92).
- ≥30% increase in UACR was associated with an increased risk of (adjusted HR [aHR]; 95% CI):
- Compared with stable values, a combined increase in UACR and decrease in eGFR was associated with an increased risk of (aHR; 95% CI):
- advanced CKD (15.15; 12.43-18.46); and
- kidney failure (16.68; 7.80-35.69).
- Combined changes in UACR and eGFR improved the discrimination of advanced CKD better than either alone.
Limitations
- Risk of selection bias and residual confounding.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.