Kidney Week

Abstract: FR-PO462

Urinary Renin and Angiotensinogen for Predicting Antiproteinuric Effect of Angiotensin Receptor Blocker

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  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

• Kim, Do Hee, Chungbuk National University Hospital, Cheongju, Korea (the Republic of)

Do Hee Kim,

• Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon,

• Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang,

• Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee,

• Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Wooseong Huh,

• Kim, Hye-Young, Chungbuk National University Hospital, Cheongju, Korea (the Republic of)

Hye-Young Kim,

• Kim, Dae Joong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Dae Joong Kim,

• Oh, Ha Young, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Ha Young Oh,

• Kim, Yoon-Goo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoon-Goo Kim,

Background

Although urinary angiotensinogen (AGT) and renin were reported to reflect the activity of intrarenal renin-angiotensin system which is known to be activated in proteinuric chronic kidney disease patients, the clinical value of urinary AGT and renin during antiproteinuric treatment is yet to be determined. In this study, we investigated the clinical impact of baseline urinary AGT or renin on the antiproteinuric effect of angiotensin receptor blocker (ARB).

Methods

A multicenter, prospective observational cohort study was conducted in 205 patients with overt proteinuria (urinary protein/creatinine ratio [uPCR] ≥ 1 mg/mgCr) between April 2009 and December 2011. Low salt diet was thoroughly educated in all patients at the time of enrollment. Baseline urinary AGT/creatinine ratio (uAGT/Cr), renin/creatinine ratio (uR/Cr), and sodium/creatinine ratio (uNa/Cr) were measured before starting valsartan. The uPCR was followed up at 2 months and 6 months in all patients. A total of 60 patients were followed up for 5 years.

Results

The mean age of patients was 47.6 ± 12.5 years and 51.2% were male. The uPCR was 2.32 ± 1.43 mg/mgCr and the estimated glomerular filtration rate was 63.2 ±28.8 ml/min/1.73m². The uNa/Cr was 1.30 ± 1.25 mg/mgCr. Natural logarithms of uAGT/Cr (ln[uAGT/Cr]) and uR/Cr (ln[uR/Cr]) were significantly higher in 53 patients with uPCR decrement greater than 1mg/mgCr at 6 months. uNa/Cr was higher in patients with uPCR decrement greater than 1 mg/mgCr at 2 months. Multivariable regression analysis identified uNa/Cr as a significant factor associated with the degree of uPCR decrement at 6 months (β = -0.206, P = 0.047). Ln(uR/Cr) was identified as a predictive factor (OR 1.244, 95% CI 1.04-1.49, P = 0.018) for uPCR decrement higher than 1 mg/mgCr at 6 months in logistic regression analysis.

Conclusion

Our study showed that baseline ln(uR/Cr) and uNa/Cr have the potential to be used as prognostic markers predicting antiproteinuric effect of ARB. The clinical importance of low salt diet education was also shown.