title: Proteinuria as a Therapeutic Target in Advanced Chronic Kidney Disease: a Retrospective Multicenter Cohort Study.
abstract: Current evidence of proteinuria reduction as a surrogate target in advanced chronic kidney disease (CKD) is incomplete due to lack of patient-pooled database. We retrospectively studied a multicenter cohort of 1891 patients who were enrolled in the nationwide multidisciplinary pre-end stage renal disease care program with a baseline glomerular filtration rate (GFR) <45 mL/min/1.73 m(2) and followed longitudinally to investigate the effect of the change in proteinuria on renal death (defined as composite of dialysis and death occurring before initiation of dialysis). The group with a change in proteinuria ≤0.30 g/g (n = 1261) had lower cumulative probabilities of renal death (p < 0.001). In a linear regression model, a higher baseline proteinuria and a greater increase in proteinuria were associated with faster annual GFR decline. Cox's analysis showed that every 1 unit increase in natural log(baseline proteinuria, 10 g/g) and every 0.1 g/g increase in the change in proteinuria resulted in 67% (HR = 1.67, 95% CI: 1.46-1.91) and 1% (HR = 1.01, 95% CI: 1.01-1.01) greater risk of renal death respectively after adjusting for the effects of the other covariates. Our study provided a patient-based evidence to support proteinuria as a therapeutic target in advanced CKD.
authors.affiliation: Division of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan.
authors.forename: Chang-Hsu
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Hon-Yen
authors.initials: HY
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.
authors.forename: Chieh-Li
authors.initials: CL
authors.lastname: Wang
authors.affiliation: Division of Nephrology, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan.
authors.forename: Feng-Jung
authors.initials: FJ
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Da Chien General Hospital, Miaoli County, Taiwan.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Buddhist Tzu Chi Hospital Taipei Branch, New Taipei City, Taiwan.
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Department of Nephrology, Chi Mei Medical Center, Tainan City, Taiwan.
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Kan
authors.affiliation: Division of Nephrology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000652:urine*; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
chemical_list: D003404:Creatinine