Abstract: FR-PO403

Changes in Albuminuria and Subsequent Risk of Incident Kidney Disease

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • George, Koshy K, University of Queensland, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Lu, Jun Ling, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Albuminuria is a robust predictor of CKD progression. However, little is known about the associations of changes in albuminuria with the risk of kidney events outside the settings of clinical trials.

Methods

In a nationwide cohort of 56,946 U.S. veterans with at least two albuminuria measurements and an eGFR ≥60 mL/min/1.73 m2 between 2004 and 2006, we examined the associations of 1-year fold changes in albuminuria with incident CKD (>25% decrease of eGFR upon reaching <60 mL/min/1.73 m2) and rapid eGFR decline (eGFR slope <-5 mL/min/1.73 m2 per year), assessed using Cox models and logistic regression models, respectively, with adjustment for potential confounders.

Results

The mean (SD) age was 64.2 (10.4) years; 97% were male; and 91% were diabetic. There was a near linear association between 1-year fold changes in albuminuria and incident CKD (Figure). The multivariable-adjusted hazard ratios (95% CI) of incident CKD associated with 1-year albuminuria fold changes of <0.5, 0.5-<0.75, 1.25-<2, and ≥2 (vs. 0.75-<1.25) fold were 0.82 (0.76-0.88), 0.93 (0.86-1.00), 1.12 (1.05-1.20), and 1.29 (1.21-1.38), respectively. Qualitatively similar associations were present for rapid eGFR decline (adjusted odds ratios [95% CI] for albuminuria changes <0.5, 0.5-<0.75, 1.25-<2, and ≥2 [vs. 0.75-<1.25] fold, 0.86 [0.78-0.94], 0.98 [0.89-1.07], 1.18 [1.08-1.28], and 1.67 [1.54-1.81], respectively).

Conclusion

Changes in albuminuria were associated with subsequent risk of incident CKD and rapid eGFR decline. Further studies are warranted to test whether active interventions aimed at lowering elevated albuminuria can improve kidney outcomes.

Funding

  • NIDDK Support