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Urinary creatinine excretion, measured glomerular filtration rate and CKD outcomes.
Nephrol Dial Transplant. 2015 Aug; 30(8):1386-94.ND

Abstract

BACKGROUND

Muscle wasting predicts mortality in patients with end-stage renal disease (ESRD), but its role in the progression of chronic kidney disease (CKD) is uncertain. We studied CKD outcomes associated with low muscle mass, assessed by urinary creatinine excretion (UCr).

METHODS

The NephroTest cohort included 1429 patients with CKD stages 1-4 and both measured glomerular filtration rate (mGFR) (by (51)Cr-EDTA) and estimated glomerular filtration rate (eGFR) (by CKD-Epidemiology Collaboration equation). We used cause-specific Cox models to estimate hazard ratios (HRs) for the competing risks of ESRD and death associated with gender-specific UCr quartiles.

RESULTS

UCr was 13.6 ± 3.2 mmol/24 h (0.17 ± 0.05 mmol/kg/24 h) in men and 9.2 ± 2.1 (0.14 ± 0.05) in women. It was positively associated with mGFR, but not with eGFR. Over a median follow-up of 3.6 (2.1-5.8) years, 229 patients developed ESRD and 113 patients died before ESRD. Compared with patients in the highest UCr quartile, those in the lowest quartile had a higher crude HR (95% confidence interval) for pre-ESRD death: 4.3 (2.4-7.7), which was weakened, but remained statistically significant, independent of demographics, mGFR and several other factors: 2.1 (1.04-4.3). Their crude ESRD risk was not higher: HR: 0.95 (0.65-1.4), and even tended to be lower after adjusting for mGFR and log-proteinuria: HR: 0.70 (0.45-1.1). Adjustment for eGFR instead of mGFR reversed this relationship: HR: 1.7 (1.1-2.7).

CONCLUSIONS

In early stage CKD, low UCr is associated with higher risk for mortality, but not for ESRD. Using creatinine-based equation to adjust for GFR may bias the relationship of UCr with ESRD risk.

Authors+Show Affiliations

Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France University Paris-Sud, UMRS 1018, Villejuif, France.Department of Physiology, AP-HP, Hôpital Bichat, Paris, France University Paris Diderot, Paris, UMR 1149, Paris, France.Department of Physiology, AP-HP, Hôpital Tenon, Paris, France Inserm UMR-S 1155, Paris, France Paris and Sorbonne University, UPMC University-Paris 6, Paris, France.Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France University Paris-Sud, UMRS 1018, Villejuif, France.Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France DHU Common and Rare Arterial Diseases, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.Inserm UMR-S 1155, Paris, France Paris and Sorbonne University, UPMC University-Paris 6, Paris, France Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France.University Paris Diderot, Paris, UMR 1149, Paris, France Department of Nephrology, AP-HP, Hôpital Bichat, Paris, France.University Paris Descartes-Paris 5, UMRS 775, Paris, France Department of Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France.Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France University Paris-Sud, UMRS 1018, Villejuif, France.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25817225

Citation

Tynkevich, Elena, et al. "Urinary Creatinine Excretion, Measured Glomerular Filtration Rate and CKD Outcomes." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 30, no. 8, 2015, pp. 1386-94.
Tynkevich E, Flamant M, Haymann JP, et al. Urinary creatinine excretion, measured glomerular filtration rate and CKD outcomes. Nephrol Dial Transplant. 2015;30(8):1386-94.
Tynkevich, E., Flamant, M., Haymann, J. P., Metzger, M., Thervet, E., Boffa, J. J., Vrtovsnik, F., Houillier, P., Froissart, M., & Stengel, B. (2015). Urinary creatinine excretion, measured glomerular filtration rate and CKD outcomes. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 30(8), 1386-94. https://doi.org/10.1093/ndt/gfv047
Tynkevich E, et al. Urinary Creatinine Excretion, Measured Glomerular Filtration Rate and CKD Outcomes. Nephrol Dial Transplant. 2015;30(8):1386-94. PubMed PMID: 25817225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary creatinine excretion, measured glomerular filtration rate and CKD outcomes. AU - Tynkevich,Elena, AU - Flamant,Martin, AU - Haymann,Jean-Philippe, AU - Metzger,Marie, AU - Thervet,Eric, AU - Boffa,Jean-Jacques, AU - Vrtovsnik,François, AU - Houillier,Pascal, AU - Froissart,Marc, AU - Stengel,Bénédicte, AU - ,, Y1 - 2015/03/27/ PY - 2014/07/25/received PY - 2015/01/28/accepted PY - 2015/3/31/entrez PY - 2015/3/31/pubmed PY - 2016/2/26/medline KW - chronic kidney disease KW - end-stage renal disease KW - glomerular filtration rate KW - mortality KW - muscle mass loss KW - urinary creatinine excretion SP - 1386 EP - 94 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 30 IS - 8 N2 - BACKGROUND: Muscle wasting predicts mortality in patients with end-stage renal disease (ESRD), but its role in the progression of chronic kidney disease (CKD) is uncertain. We studied CKD outcomes associated with low muscle mass, assessed by urinary creatinine excretion (UCr). METHODS: The NephroTest cohort included 1429 patients with CKD stages 1-4 and both measured glomerular filtration rate (mGFR) (by (51)Cr-EDTA) and estimated glomerular filtration rate (eGFR) (by CKD-Epidemiology Collaboration equation). We used cause-specific Cox models to estimate hazard ratios (HRs) for the competing risks of ESRD and death associated with gender-specific UCr quartiles. RESULTS: UCr was 13.6 ± 3.2 mmol/24 h (0.17 ± 0.05 mmol/kg/24 h) in men and 9.2 ± 2.1 (0.14 ± 0.05) in women. It was positively associated with mGFR, but not with eGFR. Over a median follow-up of 3.6 (2.1-5.8) years, 229 patients developed ESRD and 113 patients died before ESRD. Compared with patients in the highest UCr quartile, those in the lowest quartile had a higher crude HR (95% confidence interval) for pre-ESRD death: 4.3 (2.4-7.7), which was weakened, but remained statistically significant, independent of demographics, mGFR and several other factors: 2.1 (1.04-4.3). Their crude ESRD risk was not higher: HR: 0.95 (0.65-1.4), and even tended to be lower after adjusting for mGFR and log-proteinuria: HR: 0.70 (0.45-1.1). Adjustment for eGFR instead of mGFR reversed this relationship: HR: 1.7 (1.1-2.7). CONCLUSIONS: In early stage CKD, low UCr is associated with higher risk for mortality, but not for ESRD. Using creatinine-based equation to adjust for GFR may bias the relationship of UCr with ESRD risk. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/25817225/Urinary_creatinine_excretion_measured_glomerular_filtration_rate_and_CKD_outcomes_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfv047 DB - PRIME DP - Unbound Medicine ER -