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The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension.
Arch Intern Med. 2005 Apr 25; 165(8):947-53.AI

Abstract

BACKGROUND

The magnitude of proteinuria is associated with a graded increase in the risk of progression to end-stage renal disease and cardiovascular events. The objective of this study was to relate baseline and early changes in proteinuria and glomerular filtration rate (GFR) to long-term progression of hypertensive nondiabetic kidney disease.

METHODS

Post hoc analysis of a randomized 3 x 2 factorial trial. A total of 1094 African Americans with hypertensive renal disease (GFR, 20-65 mL/min per 1.73 m(2)) were followed up for a median of 3.8 years. Participants were randomized to a mean arterial pressure goal of 102 to 107 mm Hg (usual) or 92 mm Hg or less (lower) and to initial treatment with a beta-blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ramipril), or a dihydropyridine calcium channel blocker (amlodipine)

RESULTS

Baseline proteinuria and GFR predicted the rgate of GFR decline. For each 10-mL/min per 1.73 m(2) lower baseline GFR, an associated mean +/- SE 0.38 +/- 0.08-mL/min per 1.73 m(2) per year greater mean GFR decline occurred, and for each 2-fold higher proteinuria level, a mean +/- SE 0.54 +/- 0.05-mL/min per 1.73 m(2) per year faster GFR decline was observed (P < .001 for both). In multivariate analysis, the effect of baseline proteinuria GFR decline persisted. Initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d.

CONCLUSIONS

The change in the level of proteinuria is a predictor of subsequent progression of hypertensive kidney disease at a given GFR. A prospective trial is needed to confirm this observation.

Authors+Show Affiliations

Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15851648

Citation

Lea, Janice, et al. "The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease: Results of the African American Study of Kidney Disease and Hypertension." Archives of Internal Medicine, vol. 165, no. 8, 2005, pp. 947-53.
Lea J, Greene T, Hebert L, et al. The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Arch Intern Med. 2005;165(8):947-53.
Lea, J., Greene, T., Hebert, L., Lipkowitz, M., Massry, S., Middleton, J., Rostand, S. G., Miller, E., Smith, W., & Bakris, G. L. (2005). The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Archives of Internal Medicine, 165(8), 947-53.
Lea J, et al. The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease: Results of the African American Study of Kidney Disease and Hypertension. Arch Intern Med. 2005 Apr 25;165(8):947-53. PubMed PMID: 15851648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. AU - Lea,Janice, AU - Greene,Tom, AU - Hebert,Lee, AU - Lipkowitz,Michael, AU - Massry,Shaul, AU - Middleton,John, AU - Rostand,Stephen G, AU - Miller,Edgar, AU - Smith,Winifred, AU - Bakris,George L, PY - 2005/4/27/pubmed PY - 2005/5/18/medline PY - 2005/4/27/entrez SP - 947 EP - 53 JF - Archives of internal medicine JO - Arch Intern Med VL - 165 IS - 8 N2 - BACKGROUND: The magnitude of proteinuria is associated with a graded increase in the risk of progression to end-stage renal disease and cardiovascular events. The objective of this study was to relate baseline and early changes in proteinuria and glomerular filtration rate (GFR) to long-term progression of hypertensive nondiabetic kidney disease. METHODS: Post hoc analysis of a randomized 3 x 2 factorial trial. A total of 1094 African Americans with hypertensive renal disease (GFR, 20-65 mL/min per 1.73 m(2)) were followed up for a median of 3.8 years. Participants were randomized to a mean arterial pressure goal of 102 to 107 mm Hg (usual) or 92 mm Hg or less (lower) and to initial treatment with a beta-blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ramipril), or a dihydropyridine calcium channel blocker (amlodipine) RESULTS: Baseline proteinuria and GFR predicted the rgate of GFR decline. For each 10-mL/min per 1.73 m(2) lower baseline GFR, an associated mean +/- SE 0.38 +/- 0.08-mL/min per 1.73 m(2) per year greater mean GFR decline occurred, and for each 2-fold higher proteinuria level, a mean +/- SE 0.54 +/- 0.05-mL/min per 1.73 m(2) per year faster GFR decline was observed (P < .001 for both). In multivariate analysis, the effect of baseline proteinuria GFR decline persisted. Initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d. CONCLUSIONS: The change in the level of proteinuria is a predictor of subsequent progression of hypertensive kidney disease at a given GFR. A prospective trial is needed to confirm this observation. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15851648/The_relationship_between_magnitude_of_proteinuria_reduction_and_risk_of_end_stage_renal_disease:_results_of_the_African_American_study_of_kidney_disease_and_hypertension_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.165.8.947 DB - PRIME DP - Unbound Medicine ER -