Kidney Week

Abstract: PO2304

Plasma Proenkephalin and Incident CKD in REGARDS

Session Information

• CKD: Drugs, Diet, and Other Determinants
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Bullen, Alexander, VA San Diego Healthcare System, San Diego, California, United States

Alexander Bullen, MD

• Katz, Ronit, University of Washington, Seattle, Washington, United States

Ronit Katz,

• Gutierrez, Orlando M., The University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, United States

Orlando M. Gutierrez,

• Rifkin, Dena E., VA San Diego Healthcare System, San Diego, California, United States

Dena E. Rifkin,

• Cushman, Mary, University of Vermont, Burlington, Vermont, United States

Mary Cushman,

• Ix, Joachim H., VA San Diego Healthcare System, San Diego, California, United States

Joachim H. Ix,

Background

Plasma proenkephalin (PENK) is a precursor of active enkephalins. Higher blood concentrations have been previously associated with eGFR decline. Whether PENK concentrations vary by race and whether the association of PENK with incident CKD differs by race is uncertain.

Methods

In a nested cohort of 3,986 community-living participants within the REGARDS cohort, we measured PENK by ELISA. Primary outcomes were incident CKD (new eGFR < 60 mL/min/1.73m² plus 40% decline), significant eGFR decline (30% decline) and incident albuminuria (new UACR > 30mg/g) at a follow-up visit 9.4 years (mean) after baseline. We used logistic regression with inverse probability sampling weights for analysis, evaluating PENK per 2-fold higher level. We tested race interactions, and explored analyses stratified by race.

Results

Mean age was 63 years, 48% were black, and 51% were female. Baseline eGFR was 88 ml/min/1.73m². Higher PENK was associated with all 3 outcomes in unadjusted models. In the fully adjusted models, higher PENK remained associated with significant eGFR decline and incident albuminuria. Associations differed by race. P for interaction between PENK and race was <0.01. Higher PENK was more strongly associated with incident CKD and eGFR decline and incident albuminuria in Blacks.

Conclusion

In community-living individuals, higher PENK is associated with significant eGFR decline and incident albuminuria, independent of eGFR, albuminuria and CKD risk factors. These associations differed by race. Future studies should determine if PENK has utility to improve eGFR risk estimation without requiring race-specific adjustments in estimates.

Funding

• Veterans Affairs Support