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Kidney Week

Abstract: FR-PO487

Change in Albuminuria and Risk of ESKD in a Global Consortium

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular


  • Coresh, Josef, CKD Prognosis Consortium, Baltimore, Maryland, United States

Albuminuria and proteinuria are used in chronic kidney disease (CKD) staging, but it is uncertain how change in these markers is associated with ESKD risk in clinical settings.


CKD-PC cohorts with multiple albumin or protein to creatinine ratio (ACR & PCR) measurements within a 2-year baseline period and subsequent ESKD risk were analyzed using Cox regression. Random effects meta-analysis results are presented and absolute risk was modeled.


76,234 participants (age 59 y, 47% female, 64% diabetic) had ≥2 ACR or PCR measurements during a 2-year baseline period, and were subsequently followed for over 5 years during which 3,181 ESKD events occurred in 14 cohorts. Adjusted for initial levels of ACR, eGFR and covariates, changes in both ACR (Figure, 10 cohorts) and PCR (9 cohorts) were linearly related to log hazard ratio (HR) of ESRD: 4-fold decrease and 4-fold increase had HRs (95% CI) of 0.53 (0.4-0.7) and 2.6 (1.8-3.8) for ACR and 0.48 (0.3-0.7) and 2.2 (1.7-2.9) for PCR. Results were consistent in most subgroups (DM, HTN, RAASI use, BP change and age) except baseline ACR where HRs for 4-fold decrease in ACR were stronger at higher baseline ACR. Absolute risk differences of ESKD associated with a 4-fold decrease were much larger at higher baseline ACR or PCR and follow-up time.


Change in ACR and PCR were consistently associated with risk of ESKD, beyond baseline eGFR, ACR and change in eGFR, informing their use as outcomes in clinical practice, observational and clinical trial research, and for regulatory purposes.


  • NIDDK Support