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Abstract: FR-PO431

Low Proteinuria Is Associated with Increased Mortality in Incident Dialysis Patients: Results from the CRIC Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Hishida, Manabu, Johns Hopkins School of Public Health, Baltimore, Maryland, United States
  • Ishigami, Junichi, Johns Hopkins School of Public Health, Baltimore, Maryland, United States
  • Shafi, Tariq, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Lora, Claudia M., University of Illinois at Chicago, Chicago, Illinois, United States
  • Townsend, Raymond R., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States
  • Taliercio, Jonathan J., Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Appel, Lawrence J., Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
  • Matsushita, Kunihiro, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

In multiple studies, increased levels of proteinuria are associated with worse outcomes. However, in individuals with glomerular filtration rate <30 ml/min, some studies have reported a J-shaped association of proteinuria with mortality. However, this association has not been examined in incident dialysis patients.


Among 725 incident dialysis participants in the CRIC Study (mean age 60.1 [SD 11.4] years, 32.4% White, 54.2% Black, 59.0% men), we evaluated the association of pre-dialysis urinary protein-to-creatinine ratio (PCR) within two years of dialysis initiation (<0.5, 0.5- 0.9, 1.0- 3.4, ≥3.5 [g/g]) with mortality (333 deaths during the median follow-up of 3.5 years) using Cox models adjusting for potential confounders (e.g. blood pressure, serum albumin, history of cardiovascular disease including heart failure).


Participants with the lowest PCR level, <0.5 g/g, were likely to be older and had lower blood pressure compared to those with higher proteinuria. We observed a J-shaped association with the highest mortality risk in the lowest PCR category (<0.5 [g/g]) (crude hazard ratio 2.69 [95%CI 1.79-4.04] vs. PCR of 0.5- <0.9) followed by the highest PCR category (1.46 [1.01-2.10]) (Table). The excess risk in persons with the lowest PCR level was attenuated but still statistically significant after accounting for potential confounders.


Among incident dialysis patients, there was a J-shaped association between pre-dialysis proteinuria and elevated risk of mortality, with the highest risk in the lowest PCR category. While the reasons for this association are uncertain, our findings suggest that healthcare providers should be aware that low protein excretion, not just high protein excretion, is a marker for an increased risk of mortality in patients who start dialysis.


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