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Albuminuria, Proteinuria, and Renal Disease Progression in Children with CKD.
Clin J Am Soc Nephrol. 2017 Jun 07; 12(6):912-920.CJ

Abstract

BACKGROUND AND OBJECTIVES

The role of albuminuria as an indicator of progression has not been investigated in children with CKD in the absence of diabetes.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Children were enrolled from 49 centers of the CKD in Children study between January of 2005 and March of 2014. Cross-sectional multivariable linear regression (n=647) was used to examine the relationship between urine protein-to-creatinine (UP/C [milligrams per milligram]) and albumin-to-creatinine (ACR [milligrams per gram]) with eGFR (milliliters per minute per 1.73 m2). Parametric time-to-event analysis (n=751) was used to assess the association of UP/C, ACR, and urine nonalbumin-to-creatinine (Unon-alb/cr [milligrams per gram]) on the time to the composite endpoint of initiation of RRT or 50% decline in eGFR.

RESULTS

The median follow-up time was 3.4 years and 202 individuals experienced the event. Participants with a UP/C≥0.2 mg/mg and ACR≥30 mg/g had a mean eGFR that was 16 ml/min per 1.73 m2 lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. Individuals with ACR<30 mg/g, but a UP/C≥0.2 mg/mg, had a mean eGFR that was 9.3 ml/min per 1.73 m2 lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. When categories of ACR and Unon-alb/cr were created on the basis of clinically meaningful cutoff values of UP/C with the same sample sizes for comparison, the relative times (RTs) to the composite end-point were almost identical when comparing the middle (RT=0.31 for UP/C [0.2-2.0 mg/mg], RT=0.38 for ACR [56-1333 mg/g], RT=0.31 for Unon-alb/cr [118-715 mg/g]) and the highest (RT=0.08 for UP/C [>2.0 mg/mg], RT=0.09 for ACR [>1333 mg/g], RT=0.07 for Unon-alb/cr [>715 mg/g]) levels to the lowest levels. A similar trend was seen when categories were created on the basis of clinically meaningful cutoff values of ACR (<30, 30-300, >300 mg/g).

CONCLUSIONS

In children with CKD without diabetes, the utility of an initial UP/C, ACR, and Unon-alb/cr for characterizing progression is similar.

Authors+Show Affiliations

Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. george_schwartz@urmc.rochester.edu.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

28546440

Citation

Fuhrman, Dana Y., et al. "Albuminuria, Proteinuria, and Renal Disease Progression in Children With CKD." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 6, 2017, pp. 912-920.
Fuhrman DY, Schneider MF, Dell KM, et al. Albuminuria, Proteinuria, and Renal Disease Progression in Children with CKD. Clin J Am Soc Nephrol. 2017;12(6):912-920.
Fuhrman, D. Y., Schneider, M. F., Dell, K. M., Blydt-Hansen, T. D., Mak, R., Saland, J. M., Furth, S. L., Warady, B. A., Moxey-Mims, M. M., & Schwartz, G. J. (2017). Albuminuria, Proteinuria, and Renal Disease Progression in Children with CKD. Clinical Journal of the American Society of Nephrology : CJASN, 12(6), 912-920. https://doi.org/10.2215/CJN.11971116
Fuhrman DY, et al. Albuminuria, Proteinuria, and Renal Disease Progression in Children With CKD. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):912-920. PubMed PMID: 28546440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Albuminuria, Proteinuria, and Renal Disease Progression in Children with CKD. AU - Fuhrman,Dana Y, AU - Schneider,Michael F, AU - Dell,Katherine M, AU - Blydt-Hansen,Tom D, AU - Mak,Robert, AU - Saland,Jeffrey M, AU - Furth,Susan L, AU - Warady,Bradley A, AU - Moxey-Mims,Marva M, AU - Schwartz,George J, Y1 - 2017/05/25/ PY - 2016/11/22/received PY - 2017/02/21/accepted PY - 2017/5/27/pubmed PY - 2018/3/20/medline PY - 2017/5/27/entrez KW - Cross-Sectional Studies KW - Disease Progression KW - Follow-Up Studies KW - Humans KW - Linear Models KW - Renal Insufficiency, Chronic KW - Renal Replacement Therapy KW - Sample Size KW - albuminuria KW - creatinine KW - diabetes mellitus KW - glomerular filtration rate KW - kidney KW - pediatrics KW - progression of chronic renal failure KW - proteinuria KW - renal function decline SP - 912 EP - 920 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 6 N2 - BACKGROUND AND OBJECTIVES: The role of albuminuria as an indicator of progression has not been investigated in children with CKD in the absence of diabetes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Children were enrolled from 49 centers of the CKD in Children study between January of 2005 and March of 2014. Cross-sectional multivariable linear regression (n=647) was used to examine the relationship between urine protein-to-creatinine (UP/C [milligrams per milligram]) and albumin-to-creatinine (ACR [milligrams per gram]) with eGFR (milliliters per minute per 1.73 m2). Parametric time-to-event analysis (n=751) was used to assess the association of UP/C, ACR, and urine nonalbumin-to-creatinine (Unon-alb/cr [milligrams per gram]) on the time to the composite endpoint of initiation of RRT or 50% decline in eGFR. RESULTS: The median follow-up time was 3.4 years and 202 individuals experienced the event. Participants with a UP/C≥0.2 mg/mg and ACR≥30 mg/g had a mean eGFR that was 16 ml/min per 1.73 m2 lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. Individuals with ACR<30 mg/g, but a UP/C≥0.2 mg/mg, had a mean eGFR that was 9.3 ml/min per 1.73 m2 lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. When categories of ACR and Unon-alb/cr were created on the basis of clinically meaningful cutoff values of UP/C with the same sample sizes for comparison, the relative times (RTs) to the composite end-point were almost identical when comparing the middle (RT=0.31 for UP/C [0.2-2.0 mg/mg], RT=0.38 for ACR [56-1333 mg/g], RT=0.31 for Unon-alb/cr [118-715 mg/g]) and the highest (RT=0.08 for UP/C [>2.0 mg/mg], RT=0.09 for ACR [>1333 mg/g], RT=0.07 for Unon-alb/cr [>715 mg/g]) levels to the lowest levels. A similar trend was seen when categories were created on the basis of clinically meaningful cutoff values of ACR (<30, 30-300, >300 mg/g). CONCLUSIONS: In children with CKD without diabetes, the utility of an initial UP/C, ACR, and Unon-alb/cr for characterizing progression is similar. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28546440/Albuminuria_Proteinuria_and_Renal_Disease_Progression_in_Children_with_CKD_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=28546440 DB - PRIME DP - Unbound Medicine ER -