Kidney Week

Abstract: FR-PO403

Changes in Albuminuria and Subsequent Risk of Incident Kidney Disease

Session Information

• CKD: Risk Factors for Incidence and Progression - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

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

Keiichi Sumida,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• George, Koshy K, University of Queensland, Memphis, Tennessee, United States

Koshy K George,

• Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Lu, Jun Ling, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Jun Ling Lu,

• Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan

Kunihiro Yamagata,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

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