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Abstract: SA-PO927

Influence of Urine Creatinine Concentration on the Prognostic Value of Proteinuria for Major Adverse Cardiovascular Events in Patients With CKD: Findings From the KNOW-CKD Study

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Oh, Yun Jung, H Plus Yangji Hospital, Seoul, Korea (the Republic of)
  • Oh, Kook-Hwan, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Jung, Ji Yong, Gachon University Gil Medical Center, Incheon, Incheon, Korea (the Republic of)
Background

Proteinuria is typically quantified according to the spot urine protein−creatinine ratio (UPCR) and an association with cardiovascular events has not been thoroughly investigated in chronic kidney disease (CKD) patients. We investigated whether the severity of proteinuria assessed by spot UPCR is associated with an increased risk for cardiovascular outcomes in the CKD population, and whether the relationship is influenced by urine creatinine concentration.

Methods

We analyzed 1,746 patients enrolled as part of The KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). Multivariable Cox proportional hazard analysis was performed to evaluate models with proteinuria as a predictor of renal events and extended major adverse cardiovascular events (eMACEs).

Results

Risk for renal events was significantly associated with proteinuria across all eGFR and UPCR categories. By contrast, risk for eMACEs increased significantly with UPCR in patients with eGFR ≥ 60 mL/min/1.73 m2 (hazard ratio [HR] = 2.051; 95% confidence interval [CI] = 1.359−3.096; P = 0.001), but not in patients with eGFR <60 mL/min/1.73 m2 (HR = 1.083; 95% CI = 0.914−1.283; P = 0.358). However, in those with the lower eGFR, risk for eMACEs increased significantly with UPCR in participants with urine creatinine concentration ≥ 95 mg/dL (HR = 1.480; 95% CI = 1.045-2.097; P = 0.027).

Conclusion

In non-dialysis CKD patients, the prognostic value of UPCR for eMACEs is weakened in patients with reduced eGFR levels, for whom it has prognostic significance only in patients with high urine creatinine concentration.