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Abstract: FR-PO949

Association Between Changes in Urinary Albumin and Protein Excretion and Risk of Kidney Failure in Patients with CKD: The CKD-JAC Study

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Toyama, Tadashi, Kanazawa Daigaku, Kanazawa, Ishikawa, Japan
  • Imaizumi, Takahiro, Nagoya Daigaku, Nagoya, Aichi, Japan
  • Fujii, Naohiko, Hyogo Kenritsu Nishinomiya Byoin, Nishinomiya, Hyogo, Japan
  • Hasegawa, Takeshi, Showa Daigaku, Shinagawa-ku, Tokyo, Japan
  • Komaba, Hirotaka, Tokai Daigaku, Hiratsuka, Kanagawa, Japan
  • Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Fukagawa, Masafumi, Tokai Daigaku, Hiratsuka, Kanagawa, Japan

There has been progress in studying albuminuria as a surrogate endpoint for kidney failure with replacement therapy (KFRT) in patients with chronic kidney disease (CKD). However, the relationship between changes in proteinuria and KFRT has not been well studied.


The Chronic Kidney Disease - Japan Cohort (CKD-JAC) is a prospective observational study of patients with CKD in Japan. This study used the CKD-JAC cohort to examine the associations between a twofold increase in albuminuria (urine albumin-creatinine ratio) within the first two years of follow-up and the subsequent development of KFRT. In addition, in the subgroup with available proteinuria during follow-up, the relationship between the doubling of proteinuria (urine protein-creatinine ratio) in the first and second year and KFRT was examined in a similar way. A multivariable Cox proportional hazards model was used for analyses.


The study analyzed 1,753 patients with an average age of 60 years, a mean eGFR of 30 mL/min/1.73 m2, and a mean albuminuria of 419 mg/gCr. During the observation period, 618 patients (35.2%) initiated kidney replacement therapy. The hazard ratio (HR) and 95% confidence interval of KFRT for a doubling of albuminuria within 2 years was 1.57 (1.46, 1.70). Further analysis of the subgroup with proteinuria demonstrated that a doubling of proteinuria was associated with KFRT at the 2-year change (HR 1.41 [1.25, 1.59]). A similar association was found for the 1-year change of proteinuria as well (HR 1.30 [1.15, 1.47]).


In subjects with CKD, a doubling of albuminuria within the first two years of follow-up could potentially serve as a surrogate endpoint for KFRT. Similarly, proteinuria could also be a surrogate endpoint for KFRT.


  • Commercial Support – Kyowa Kirin Co.,Ltd.