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Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality
Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden.;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden..
Johns Hopkins Univ, Sch Med, Div Nephrol, Baltimore, MD USA.;Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
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2017 (English)In: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 91, no 1, 244-251 p.Article in journal (Refereed) Published
Abstract [en]

Current guidelines for chronic kidney disease (CKD) recommend using albuminuria as well as estimated glomerular filtration rate (eGFR) to stage CKD. However, CKD progression is solely defined by change in eGFR with little regard to the risk implications of change in albuminuria. This is an observational study from the Stockholm CREAtinine Measurements (SCREAM) project, a health care utilization cohort from Stockholm, Sweden, with laboratory measures from 2006-2011 and follow-up through December 2012. Included were 31,732 individuals with two or more ambulatory urine albumin to creatinine ratio (ACR) tests. We assessed the association between change in ACR during a baseline period of 1, 2, or 3 years and end-stage renal disease (ESRD) or death. Using a 2-year baseline period, there were 378 ESRD events and 1712 deaths during a median of 3 years of follow-up. Compared to stable ACR, a 4-fold increase in ACR was associated with a 3.08-times (95% confidence interval 2.59 to 3.67) higher risk of ESRD while a 4-fold decrease in ACR was associated with a 0.34-times (0.26 to 0.45) lower risk of ESRD. Similar associations were found in people with and without diabetes mellitus, with and without hypertension, and also when adjusted for the change in eGFR during the same period. The association between change in ACR and mortality was weaker: ACR increase was associated with mortality, but the relationship was largely flat for ACR decline. Results were consistent for 1-, 2-, and 3-year ACR changes. Thus, changes in albuminuria are strongly and consistently associated with the risk of ESRD and death.

Place, publisher, year, edition, pages
2017. Vol. 91, no 1, 244-251 p.
Keyword [en]
albuminuria, changes in albuminuria, death, end-stage renal disease, estimated glomerular filtration rate
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-315067DOI: 10.1016/j.kint.2016.09.037ISI: 000391162700028PubMedID: 27927597OAI: oai:DiVA.org:uu-315067DiVA: diva2:1077701
Funder
Stockholm County CouncilSwedish Heart Lung FoundationSwedish Research CouncilMarianne and Marcus Wallenberg Foundation
Available from: 2017-02-28 Created: 2017-02-28 Last updated: 2017-02-28Bibliographically approved

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