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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: https://doi.org/10.1371/journal.pone.0226866

Souhrn

Introduction

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.

Methods

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.

Results

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.

Conclusions

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


Zdroje

1. Romundstad S, Holmen J, Kvenild K, Hallan H, Ellekjaer H. Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: a 4.4-year follow-up study. The Nord-Trondelag Health Study (HUNT), Norway. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2003;42(3):466–73.

2. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation. 2004;110(1):32–5. doi: 10.1161/01.CIR.0000133312.96477.48 15210602

3. Yuyun MF, Khaw KT, Luben R, Welch A, Bingham S, Day NE, et al. Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study. Int J Epidemiol. 2004;33(1):189–98. doi: 10.1093/ije/dyh008 15075168

4. Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney international. 2011;79(12):1331–40. doi: 10.1038/ki.2010.550 21289598

5. Chapter 1: Definition and classification of CKD. Kidney international supplements. 2013;3(1):19–62. doi: 10.1038/kisup.2012.64 25018975

6. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet (London, England). 2010;375(9731):2073–81.

7. Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet (London, England). 2012;380(9854):1662–73.

8. Mahmoodi BK, Matsushita K, Woodward M, Blankestijn PJ, Cirillo M, Ohkubo T, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet (London, England). 2012;380(9854):1649–61.

9. Kovesdy CP, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Molnar MZ, et al. Outcomes associated with microalbuminuria: effect modification by chronic kidney disease. Journal of the American College of Cardiology. 2013;61(15):1626–33. doi: 10.1016/j.jacc.2012.11.071 23500283

10. Hishida M, Tamai H, Morinaga T, Maekawa M, Aoki T, Tomida H, et al. Aichi cohort study of the prognosis in patients newly initiated into dialysis (AICOPP): baseline characteristics and trends observed in diabetic nephropathy. Clin Exp Nephrol. 2016;20(5):795–807. doi: 10.1007/s10157-015-1206-z 26905064

11. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2009;53(6):982–92.

12. Mahoney FI, Barthel DW. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Maryland state medical journal. 1965;14:61–5.

13. Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017.

14. Inaguma D, Murata M, Tanaka A, Shinjo H. Relationship between mortality and speed of eGFR decline in the 3 months prior to dialysis initiation. Clin Exp Nephrol. 2017;21(1):159–68. doi: 10.1007/s10157-016-1262-z 27084516

15. Tanaka A, Inaguma D, Shinjo H, Murata M, Takeda A. Presence of Atrial Fibrillation at the Time of Dialysis Initiation Is Associated with Mortality and Cardiovascular Events. Nephron. 2016;132(2):86–92. doi: 10.1159/000443314 26845776

16. Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, Greenland S, Kopple JD. Reverse epidemiology of hypertension and cardiovascular death in the hemodialysis population: the 58th annual fall conference and scientific sessions. Hypertension (Dallas, Tex: 1979). 2005;45(4):811–7.

17. Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa LY, et al. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. American journal of kidney diseases: the official journal of the National Kidney Foundation. 1999;33(3):507–17.

18. Matsushita K, Coresh J, Sang Y, Chalmers J, Fox C, Guallar E, et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. The lancet Diabetes & endocrinology. 2015;3(7):514–25.

19. Ishay A, Lavi I, Luboshitzky R. Prevalence and risk factors for asymptomatic bacteriuria in women with Type 2 diabetes mellitus. Diabetic medicine: a journal of the British Diabetic Association. 2006;23(2):185–8.

20. Ronald A, Ludwig E. Urinary tract infections in adults with diabetes. International journal of antimicrobial agents. 2001;17(4):287–92. doi: 10.1016/s0924-8579(00)00356-3 11295410

21. The trajectory of cause of death and crude mortality rate.: Japanese Society of Dialysis Therapy.; [Available from: http://docs.jsdt.or.jp/overview/pdf2017/p014.pdf/.

22. Miller WG, Bruns DE, Hortin GL, Sandberg S, Aakre KM, McQueen MJ, et al. Current issues in measurement and reporting of urinary albumin excretion. Clinical chemistry. 2009;55(1):24–38. doi: 10.1373/clinchem.2008.106567 19028824


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