title: Urinary Retinol-Binding Protein: Relationship to Renal Function and Cardiovascular Risk Factors in Chronic Kidney Disease.
abstract: The role of urinary retinol-binding protein (RBP) as a biomarker of CKD in proximal tubular diseases, glomerulopathies and in transplantation is well established. However, whether urinary RBP is also a biomarker of renal damage and CKD progression in general CKD is not known. In this study, we evaluated the association of urinary RBP with renal function and cardiovascular risk factors in the baseline data of the Progredir Study, a CKD cohort in Sao Paulo, Brazil, comprising 454 participants with stages 3 and 4 CKD. In univariate analysis, urinary RBP was inversely related to estimated glomerular filtration rate (CKD-EPI eGFR) and several cardiovascular risk factors. After adjustments, however, only CKD-EPI eGFR, albuminuria, systolic blood pressure, anemia, acidosis, and left atrium diameter remained significantly related to urinary RBP. The inverse relationship of eGFR to urinary RBP (β-0.02 ± 95CI -0.02; -0.01, p<0.0001 for adjusted model) remained in all strata of albuminuria, even after adjustments: in normoalbuminuria (β-0.008 ± 95CI (-0.02; -0.001, p = 0.03), in microalbuminuria (β-0.02 ± 95CI (-0.03; -0.02, p<0,0001) and in macroalbuminuria (β-0.02 ± 95CI (-0.03; -0.01, p<0,0001). Lastly, urinary RBP was able to significantly increase the accuracy of a logistic regression model (adjusted for sex, age, SBP, diabetes and albuminuria) in diagnosing eGFR<35 ml/min/1.73m2 (AUC 0,77, 95%CI 0,72-0,81 versus AUC 0,71, 95%CI 0,65-0,75, respectively; p = 0,05). Our results suggest that urinary RBP is significantly associated to renal function in CKD in general, a finding that expands the interest in this biomarker beyond the context of proximal tubulopathies, glomerulopathies or transplantation. Urinary RBP should be further explored as a predictive marker of CKD progression.
authors.affiliation: Nephrology Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Alice Muniz
authors.initials: MA
authors.lastname: Domingos
authors.affiliation: Nephrology Division, Kidney and Hypertension Hospital, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Silvia Regina
authors.initials: SR
authors.lastname: Moreira
authors.affiliation: Genetics Cardiovascular Laboratory, Heart's Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Luz
authors.initials: L
authors.lastname: Gomez
authors.affiliation: Clinical Center Research, University Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Goulart
authors.affiliation: Clinical Center Research, University Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo Andrade
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: Clinical Center Research, University Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Isabela
authors.initials: I
authors.lastname: Benseñor
authors.affiliation: Nephrology Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Silvia
authors.initials: S
authors.lastname: Titan