title: Re-evaluating the predictive roles of metabolic complications and clinical outcome according to eGFR levels--a four-years prospective cohort study in Taiwan.
abstract: BACKGROUND
  Metabolic complications are associated with clinical outcomes in patients with chronic kidney disease (CKD). These outcomes differ among patients according to the different stages of disease. The prevalence and association of type and number of metabolic complications with renal progression and death in patients having different eGFR levels has high clinical value, but this fact has been rarely evaluated in prospective studies.
  
  
  METHODS
  We prospectively followed a cohort of 1157 CKD patients from 2006 to death or until 2010, and evaluated the prevalence of CKD-related complications and their association with renal progression (defined as a decline in eGFR by > 50% from baseline, or end-stage renal disease requiring dialysis) and death in patients with eGFRs above and below 45 mL/min/1.73 m(2) using Cox-proportional hazard models.
  
  
  RESULTS
  The estimated rate (per 100 patient-years) of renal progression and death were 11.9 and 4.9, respectively. The eGFR thresholds determined by ROC analysis with a sensitivity of 90% for any metabolic complication were 60.8 mL/min/1.73 m(2) and 74.3 mL/min/1.73 m(2) using the MDRD and CKD Epidemiology Collaboration equations, respectively. CKD-related complications associated with renal progression in patients having eGFR < 45 mL/min/1.73 m(2) were hyperphosphatemia, anemia, microinflammation and hypoalbuminemia. Those CKD-related complications associated with death were hypoalbuminemia and hyperuricemia. Hypoalbuminemia predicted renal progression, and, hypoalbuminemia and microinflammation predicted death in patients with eGFR ≥ 45 mL/min/1.73 m(2). The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR < 45 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Hypoalbuminemia was a unique and strong predictor of renal progression and all-cause mortality in CKD patients, independent of their demographic characteristics, traditional risk factors, renal function severity, the presence of cardiovascular disease and other metabolic abnormalities. Most other metabolic complications and the number of complications (≥ 3) were associated with the clinical outcomes of patients with eGFR < 45 mL/min/1.73 m(2) rather than in those with higher eGFRs. The findings from the present study offer a novel insight into the association between metabolic complications and patient outcomes and may help to refine risk stratification according to disease stage.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Wu
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.forename: Chin-Chan
authors.initials: CC
authors.lastname: Lee
authors.forename: Chiao-Yin
authors.initials: CY
authors.lastname: Sun
authors.forename: Heng-Jung
authors.initials: HJ
authors.lastname: Hsu
authors.forename: Ming-Jui
authors.initials: MJ
authors.lastname: Hung
authors.forename: Mai-Szu
authors.initials: MS
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult