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Proteinuria as a risk marker for the progression of chronic kidney disease in patients on predialysis care and the role of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment.
Nephron Clin Pract. 2012; 121(1-2):c73-82.NC

Abstract

BACKGROUND/AIMS

Proteinuria is a risk marker for progression of chronic kidney disease (CKD) and treatment with an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEi/ARB) is beneficial in these patients. However, little is known about proteinuria and ACEi/ARB treatment in patients on specialized predialysis care. Therefore, we investigated the association of urinary protein excretion (UPE) and ACEi/ARB treatment with renal function decline (RFD) and/or the start of renal replacement therapy (RRT) in patients on predialysis care.

METHODS

In the PREPARE-1 cohort, 547 incident predialysis patients (CKD stages IV-V), referred as part of the usual care to outpatient clinics of eight Dutch hospitals, were included (1999-2001) and followed until the start of RRT, mortality, or January 1, 2008. The main outcomes were rate of RFD, estimated as the slope of available eGFR measurements, and the start of RRT.

RESULTS

Patients with mild proteinuria (>0.3 to ≤1.0 g/24 h) had an adjusted additional RFD of 0.35 ml/min/1.73 m(2)/month (95% CI: 0.01; 0.68) and a higher rate of starting RRT [adjusted HR: 1.70 (1.05; 2.77)] compared with patients without proteinuria (≤0.3 g/24 h). With every consecutive UPE category (>1.0 to ≤3.0, >3.0 to ≤6.0, and >6.0 g/24 h), RFD accelerated and the start of RRT was earlier. Furthermore, patients starting (n = 16) or continuing (n = 133) treatment with ACEi/ARBs during predialysis care had a lower rate of starting RRT compared with patients not using treatment [n = 152, adjusted HR: 0.56 (0.29; 1.08) and 0.90 (0.68; 1.20), respectively].

CONCLUSION

In patients on predialysis care, we confirmed that proteinuria is a risk marker for the progression of CKD. Furthermore, no evidence was present that the use of ACEi/ARBs is deleterious.

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Authors+Show Affiliations

de Goeij MC
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. M.C.M.de_Goeij@lumc.nl
Liem M
No affiliation info available
de Jager DJ
No affiliation info available
Voormolen N
No affiliation info available
Sijpkens YW
No affiliation info available
Rotmans JI
No affiliation info available
Boeschoten EW
No affiliation info available
Dekker FW
No affiliation info available
Grootendorst DC
No affiliation info available
Halbesma N
No affiliation info available
PREPARE-1 Study Group
No affiliation info available

MeSH

AdultAgedAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsBiomarkersDisease ProgressionFemaleFollow-Up StudiesGlomerular Filtration RateHumansMaleMiddle AgedNetherlandsProportional Hazards ModelsProteinuriaRenal Insufficiency, ChronicRenal Replacement TherapyRisk FactorsTime Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23128440

Citation

de Goeij, Moniek C M., et al. "Proteinuria as a Risk Marker for the Progression of Chronic Kidney Disease in Patients On Predialysis Care and the Role of Angiotensin-converting Enzyme Inhibitor/angiotensin II Receptor Blocker Treatment." Nephron. Clinical Practice, vol. 121, no. 1-2, 2012, pp. c73-82.
de Goeij MC, Liem M, de Jager DJ, et al. Proteinuria as a risk marker for the progression of chronic kidney disease in patients on predialysis care and the role of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment. Nephron Clin Pract. 2012;121(1-2):c73-82.
de Goeij, M. C., Liem, M., de Jager, D. J., Voormolen, N., Sijpkens, Y. W., Rotmans, J. I., Boeschoten, E. W., Dekker, F. W., Grootendorst, D. C., & Halbesma, N. (2012). Proteinuria as a risk marker for the progression of chronic kidney disease in patients on predialysis care and the role of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment. Nephron. Clinical Practice, 121(1-2), c73-82. https://doi.org/10.1159/000342392
de Goeij MC, et al. Proteinuria as a Risk Marker for the Progression of Chronic Kidney Disease in Patients On Predialysis Care and the Role of Angiotensin-converting Enzyme Inhibitor/angiotensin II Receptor Blocker Treatment. Nephron Clin Pract. 2012;121(1-2):c73-82. PubMed PMID: 23128440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proteinuria as a risk marker for the progression of chronic kidney disease in patients on predialysis care and the role of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment. AU - de Goeij,Moniek C M, AU - Liem,Madieke, AU - de Jager,Dinanda J, AU - Voormolen,Nora, AU - Sijpkens,Yvo W J, AU - Rotmans,Joris I, AU - Boeschoten,Elisabeth W, AU - Dekker,Friedo W, AU - Grootendorst,Diana C, AU - Halbesma,Nynke, AU - ,, Y1 - 2012/10/30/ PY - 2012/04/26/received PY - 2012/08/03/accepted PY - 2012/11/7/entrez PY - 2012/11/7/pubmed PY - 2013/6/21/medline SP - c73 EP - 82 JF - Nephron. Clinical practice JO - Nephron Clin Pract VL - 121 IS - 1-2 N2 - BACKGROUND/AIMS: Proteinuria is a risk marker for progression of chronic kidney disease (CKD) and treatment with an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEi/ARB) is beneficial in these patients. However, little is known about proteinuria and ACEi/ARB treatment in patients on specialized predialysis care. Therefore, we investigated the association of urinary protein excretion (UPE) and ACEi/ARB treatment with renal function decline (RFD) and/or the start of renal replacement therapy (RRT) in patients on predialysis care. METHODS: In the PREPARE-1 cohort, 547 incident predialysis patients (CKD stages IV-V), referred as part of the usual care to outpatient clinics of eight Dutch hospitals, were included (1999-2001) and followed until the start of RRT, mortality, or January 1, 2008. The main outcomes were rate of RFD, estimated as the slope of available eGFR measurements, and the start of RRT. RESULTS: Patients with mild proteinuria (>0.3 to ≤1.0 g/24 h) had an adjusted additional RFD of 0.35 ml/min/1.73 m(2)/month (95% CI: 0.01; 0.68) and a higher rate of starting RRT [adjusted HR: 1.70 (1.05; 2.77)] compared with patients without proteinuria (≤0.3 g/24 h). With every consecutive UPE category (>1.0 to ≤3.0, >3.0 to ≤6.0, and >6.0 g/24 h), RFD accelerated and the start of RRT was earlier. Furthermore, patients starting (n = 16) or continuing (n = 133) treatment with ACEi/ARBs during predialysis care had a lower rate of starting RRT compared with patients not using treatment [n = 152, adjusted HR: 0.56 (0.29; 1.08) and 0.90 (0.68; 1.20), respectively]. CONCLUSION: In patients on predialysis care, we confirmed that proteinuria is a risk marker for the progression of CKD. Furthermore, no evidence was present that the use of ACEi/ARBs is deleterious. SN - 1660-2110 UR - https://www.unboundmedicine.com/medline/citation/23128440/Proteinuria_as_a_risk_marker_for_the_progression_of_chronic_kidney_disease_in_patients_on_predialysis_care_and_the_role_of_angiotensin_converting_enzyme_inhibitor/angiotensin_II_receptor_blocker_treatment_ L2 - https://www.karger.com?DOI=10.1159/000342392 DB - PRIME DP - Unbound Medicine ER -