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Abstract: FR-PO921

Urine Creatinine Excretion and Mortality in CKD: From the KNOW-CKD Study

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Yang, Jihyun, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Sang-Eun, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Kyu-Beck, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Hyang, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Oh, Kook-Hwan, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Hyun, Young Youl, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Group or Team Name

  • KNOW-CKD Investigators
Background

Previous studies have shown that low muscle strength or function is a risk factor for poor prognosis in chronic kidney disease (CKD). However, the prognosis associated with low muscle mass is uncertain. 24-hour urine creatinine excretion is surrogate marker of muscle mass. The aim of this study is to investigate the relationship between urine creatinine excretion and mortality in predialysis CKD patients.

Methods

We analyzed 1,620 patients from the Korean Cohort Study for Outcome in Patients with CKD (KNOW-CKD). Participants were divided into four groups according to their sex-specific quartiles of baseline 24-hr urinary creatinine excretion (UCr). The study end point was all-cause death.

Results

During a follow-up of 10,519 person-years (median 7.0 years), 123 patients (7.6%) died, with a corresponding death rate of 11.7 (95% CI 9.8-14.0) per 1,000 patients-years. 65 (16.4%), 28 (6.8%), 21 (5.3%) and 9 (2.2%) patients from each 1st to 4th quartile group of sex-specific UCR died. In multivariate Cox proportional hazard analysis, there was a graded association of UCr with all-cause mortality. The adjusted hazard ratios (95% CI) of 2nd to 4th quartile were 0.51 (0.32-0.82), 0.48 (0.28-0.82) and 0.25 (0.12-0.53) compared with the 1st quartile.

Conclusion

Higher creatinine excretion is associated with lower risk of mortality in predialysis CKD patients. This association was independent of various conventional and CKD-related risk factors.

The association between urine creatinine excretion and mortality
 Model 1Model 2Model 3
Creatinine excretion quartileHazard ratio
(95% CI)
P valueHazard ratio
(95% CI)
P valueHazard ratio
(95% CI)
P value
1reference reference reference 
20.39 (0.25-0.61)<0.0010.49 (0.31-0.78)0.0020.51 (0.32-0.82)0.005
30.28 (0.17-0.47)<0.0010.43 (0.26-0.72)0.0010.48 (0.28-0.82)0.007
40.11 (0.06-0.22)<0.0010.23 (0.11-0.47)<0.0010.25 (0.12-0.53)<0.001
P for trend<0.001 <0.001 <0.001 

Model 1: unadjusted Model 2: adjusted for age, sex, economic status, education level, body mass index, systolic blood pressure, diabetes, cardiovascular disease, angiotensin-converting enzyme inhibitors or angiotensin receptor blocker and statin Model 3: model 2 + estimated glomerular filtration rate, low-density lipoprotein cholesterol, random urine protein to creatinine ratio, hemoglobin, albumin, C-reactive protein, phosphorus, calcium, parathyroid hormone, smoking, alcohol intake and physical activity

Funding

  • Government Support – Non-U.S.