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Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial.
Am J Kidney Dis. 2009 Jan; 53(1):16-25.AJ

Abstract

BACKGROUND

Tubulointerstitial damage plays an important role in chronic kidney disease (CKD) with proteinuria. Urinary kidney injury molecule 1 (KIM-1) reflects tubular KIM-1 and is considered a sensitive biomarker for early tubular damage. We hypothesized that a decrease in proteinuria by using therapeutic interventions is associated with decreased urinary KIM-1 levels.

STUDY DESIGN

Post hoc analysis of a randomized, double-blind, placebo-controlled, crossover trial.

SETTING & PARTICIPANTS

34 proteinuric patients without diabetes from our outpatient renal clinic.

INTERVENTION

Stepwise 6-week interventions of losartan, sodium restriction (low-sodium [LS] diet), their combination, losartan plus hydrochlorothiazide (HCT), and the latter plus an LS diet.

OUTCOMES & MEASUREMENTS

Urinary excretion of KIM-1, total protein, and N-acetyl-beta-d-glucosaminidase (NAG) as a positive control for tubular injury.

RESULTS

Mean baseline urine protein level was 3.8 +/- 0.4 (SE) g/d, and KIM-1 level was 1,706 +/- 498 ng/d (increased compared with healthy controls; 74 ng/d). KIM-1 level was decreased by using placebo/LS (1,201 +/- 388 ng/d; P = 0.04), losartan/high sodium (1,184 +/- 296 ng/d; P = 0.09), losartan/LS (921 +/- 176 ng/d; P = 0.008), losartan/high sodium plus HCT (862 +/- 151 ng/d; P = 0.008) and losartan/LS plus HCT (743 +/- 170 ng/d; P = 0.001). The decrease in urinary KIM-1 levels paralleled the decrease in proteinuria (R = 0.523; P < 0.001), but not blood pressure or creatinine clearance. 16 patients reached target proteinuria with protein less than 1 g/d, whereas KIM-1 levels normalized in only 2 patients. Urinary NAG level was increased at baseline and significantly decreased during the treatment periods of combined losartan plus HCT only. The decrease in urinary NAG levels was not closely related to proteinuria.

LIMITATIONS

Post hoc analysis.

CONCLUSIONS

Urinary KIM-1 level was increased in patients with nondiabetic CKD with proteinuria and decreased in parallel with proteinuria by using losartan, sodium restriction, their combination, losartan plus HCT, and the latter plus sodium restriction. These results are consistent with the hypothesis of amelioration of proteinuria-induced tubular damage. Long-term studies are warranted to evaluate whether targeting treatment on KIM-1 can improve outcomes in patients with CKD with proteinuria.

Authors+Show Affiliations

Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.No 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)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18823687

Citation

Waanders, Femke, et al. "Effect of Renin-angiotensin-aldosterone System Inhibition, Dietary Sodium Restriction, And/or Diuretics On Urinary Kidney Injury Molecule 1 Excretion in Nondiabetic Proteinuric Kidney Disease: a Post Hoc Analysis of a Randomized Controlled Trial." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 1, 2009, pp. 16-25.
Waanders F, Vaidya VS, van Goor H, et al. Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial. Am J Kidney Dis. 2009;53(1):16-25.
Waanders, F., Vaidya, V. S., van Goor, H., Leuvenink, H., Damman, K., Hamming, I., Bonventre, J. V., Vogt, L., & Navis, G. (2009). Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(1), 16-25. https://doi.org/10.1053/j.ajkd.2008.07.021
Waanders F, et al. Effect of Renin-angiotensin-aldosterone System Inhibition, Dietary Sodium Restriction, And/or Diuretics On Urinary Kidney Injury Molecule 1 Excretion in Nondiabetic Proteinuric Kidney Disease: a Post Hoc Analysis of a Randomized Controlled Trial. Am J Kidney Dis. 2009;53(1):16-25. PubMed PMID: 18823687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial. AU - Waanders,Femke, AU - Vaidya,Vishal S, AU - van Goor,Harry, AU - Leuvenink,Henri, AU - Damman,Kevin, AU - Hamming,Inge, AU - Bonventre,Joseph V, AU - Vogt,Liffert, AU - Navis,Gerjan, Y1 - 2008/09/27/ PY - 2007/02/17/received PY - 2008/07/07/accepted PY - 2008/10/1/pubmed PY - 2009/1/9/medline PY - 2008/10/1/entrez SP - 16 EP - 25 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 1 N2 - BACKGROUND: Tubulointerstitial damage plays an important role in chronic kidney disease (CKD) with proteinuria. Urinary kidney injury molecule 1 (KIM-1) reflects tubular KIM-1 and is considered a sensitive biomarker for early tubular damage. We hypothesized that a decrease in proteinuria by using therapeutic interventions is associated with decreased urinary KIM-1 levels. STUDY DESIGN: Post hoc analysis of a randomized, double-blind, placebo-controlled, crossover trial. SETTING & PARTICIPANTS: 34 proteinuric patients without diabetes from our outpatient renal clinic. INTERVENTION: Stepwise 6-week interventions of losartan, sodium restriction (low-sodium [LS] diet), their combination, losartan plus hydrochlorothiazide (HCT), and the latter plus an LS diet. OUTCOMES & MEASUREMENTS: Urinary excretion of KIM-1, total protein, and N-acetyl-beta-d-glucosaminidase (NAG) as a positive control for tubular injury. RESULTS: Mean baseline urine protein level was 3.8 +/- 0.4 (SE) g/d, and KIM-1 level was 1,706 +/- 498 ng/d (increased compared with healthy controls; 74 ng/d). KIM-1 level was decreased by using placebo/LS (1,201 +/- 388 ng/d; P = 0.04), losartan/high sodium (1,184 +/- 296 ng/d; P = 0.09), losartan/LS (921 +/- 176 ng/d; P = 0.008), losartan/high sodium plus HCT (862 +/- 151 ng/d; P = 0.008) and losartan/LS plus HCT (743 +/- 170 ng/d; P = 0.001). The decrease in urinary KIM-1 levels paralleled the decrease in proteinuria (R = 0.523; P < 0.001), but not blood pressure or creatinine clearance. 16 patients reached target proteinuria with protein less than 1 g/d, whereas KIM-1 levels normalized in only 2 patients. Urinary NAG level was increased at baseline and significantly decreased during the treatment periods of combined losartan plus HCT only. The decrease in urinary NAG levels was not closely related to proteinuria. LIMITATIONS: Post hoc analysis. CONCLUSIONS: Urinary KIM-1 level was increased in patients with nondiabetic CKD with proteinuria and decreased in parallel with proteinuria by using losartan, sodium restriction, their combination, losartan plus HCT, and the latter plus sodium restriction. These results are consistent with the hypothesis of amelioration of proteinuria-induced tubular damage. Long-term studies are warranted to evaluate whether targeting treatment on KIM-1 can improve outcomes in patients with CKD with proteinuria. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18823687/Effect_of_renin_angiotensin_aldosterone_system_inhibition_dietary_sodium_restriction_and/or_diuretics_on_urinary_kidney_injury_molecule_1_excretion_in_nondiabetic_proteinuric_kidney_disease:_a_post_hoc_analysis_of_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)01192-X DB - PRIME DP - Unbound Medicine ER -