Lower levels of proteinuria are associated with elevated mortality in incident dialysis patients

Autoři: Manabu Hishida aff001;  Tariq Shafi aff003;  Lawrence J. Appel aff001;  Shoichi Maruyama aff002;  Daijo Inaguma aff004;  Kunihiro Matsushita aff001
Působiště autorů: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America aff001;  Department of Nephrology, Graduate School of Medicine, Nagoya University, Nagoya, Japan aff002;  Johns Hopkins University School of Medicine, Baltimore, MD, United States of America aff003;  Department of Nephrology, Fujita Health University Hospital, Toyoake, Aichi, Japan aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226866



Proteinuria is a potent predictor of adverse events in general, although a few large studies have reported a J-shaped association between proteinuria and mortality in individuals with glomerular filtration rate <30 ml/min/1.73m2. However, this association has not been specifically evaluated among incident dialysis patients.


Among 1,380 Japanese patients who initiated dialysis, we quantified the association of pre-dialysis dipstick proteinuria (negative/trace, 1+, 2+, and ≥3+) with mortality using Cox models adjusting for potential confounders, such as age, gender, clinical history of hypertension, diabetes, and cardiovascular disease.


Mean age of study participants was 67.4 (SD 13.0) years, and 67.6% were men. The most common dipstick proteinuria category was ≥3+ (55.4%), followed by 2+ (31.2%), 1+ (9.9%), and negative or trace (3.5%). Patients with lower proteinuria level were older than those with higher proteinuria. Lower proteinuria was significantly associated with a higher risk of all-cause mortality, even after accounting for potential confounders (p for trend <0.001). In those with negative/trace dipstick proteinuria compared to those with dipstick proteinuria ≥3+, the adjusted hazard ratio was 2.60 [95% CI: 1.62–4.17] in the fully adjusted model. Similar findings were observed when analyses were restricted to patients older than 70 years, and when cardiovascular mortality and non-cardiovascular mortality were analyzed separately.


In incident dialysis patients, pre-dialysis proteinuria was inversely associated with mortality risk. Although future studies are needed to identify mechanisms, our findings suggest the need to carefully interpret proteinuria in patients with incident dialysis.

Klíčová slova:

Blood pressure – Cardiovascular diseases – Ejection fraction – Glomerular filtration rate – Medical dialysis – Prognosis – Proteinuria


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2019 Číslo 12