Kidney Week

Abstract: TH-PO1121

Association of Predialysis 24-Hour Urine Creatinine with Postdialysis Survival in Patients with Advanced CKD

Session Information

• CKD: Therapies, Innovations, and Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Donnelly, Lauren, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Lauren Donnelly, MS

• Epparla, Anurag, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Anurag Epparla, APN

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Kalantar-Zadeh, Kamyar, University of California Los Angeles, Los Angeles, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Muscle mass is an important nutritional marker in chronic kidney disease (CKD), yet data on the association of pre-dialysis muscle mass with post-dialysis mortality in patients with advanced CKD is limited. We examined the association between pre-dialysis 24-hour urine creatinine (24hrUC, a surrogate of muscle mass) and post-dialysis survival.

Methods

We examined a national cohort of 102,477 US Veterans who transitioned to dialysis from October 1, 2007, to March 31, 2015. We identified 3,008 patients who had at least one 24hrUC measurement in the pre-dialysis period. We examined the association of log-transformed 24hrUC with post-dialysis all-cause mortality using multivariable-adjusted Cox proportional hazard models. We used restricted cubic splines to examine non-linearity. Models were adjusted for age, race, body mass index, sex, eGFR, and comorbid conditions at the time of dialysis transition.

Results

The mean age and eGFR of the cohort was 64.6 years (SD: ±10.5) and 26.0 ml/min/1.73m² (SD: ±15.9), 62.4% were white, 96.8% were male and 88.0% were non-Hispanic. Compared to patients with lower 24hrUC, those with higher 24hrUC were more likely to be black and married, and less likely to have ischemic heart disease, congestive heart failure, peripheral vascular disease, and cerebrovascular disease. The total number of deaths was 1,892, and the mortality rate was 202.8/1000 patient-years (95% CI, 193.9–212.2). Higher 24hrUC was linearly associated with a significantly lower risk of death (multivariable adjusted hazard ratio per on log-unit higher 24hrUC: 0.63; 95% CI: 0.56 – 0.71, Figure).

Conclusion

In patients with advanced CKD, lower muscle mass in the pre-dialysis period is associated with higher post-dialysis mortality. Further studies are needed to determine if interventions aimed at improving predialysis muscle mass can result in lower post-dialysis mortality.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025rn9av7h0