TY - JOUR
T1 - Urinary Tubular Injury Biomarkers Are Associated With ESRD and Death in the REGARDS Study
AU - Dubin, Ruth F.
AU - Judd, Suzanne
AU - Scherzer, Rebecca
AU - Shlipak, Michael
AU - Warnock, David G.
AU - Cushman, Mary
AU - Sarnak, Mark
AU - Parikh, Chirag
AU - Bennett, Michael
AU - Powe, Neil
AU - Peralta, Carmen A.
N1 - Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/9
Y1 - 2018/9
N2 - Introduction: Urinary neutrophil gelatinase−associated lipocalin (uNGAL) and urinary kidney injury molecule−1 (uKIM-1) are established markers of subclinical acute kidney injury. In persons with reduced estimated glomerular filtration rate (eGFR) and albuminuria who are at high risk for end-stage renal disease (ESRD) and death, the associations of these urinary markers with incident ESRD or death is an area of active investigation. Methods: Among 1472 black and white participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study with eGFR ≤60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] cystatin, 2012) and albumin-to-creatinine ratio (ACR) ≥30 mg/g, we evaluated the associations of baseline uNGAL and uKIM-1 with progression to ESRD and all-cause death. Cox models were sequentially adjusted for urinary creatinine, traditional risk factors, C-reactive protein, ACR, and eGFR. Results: There were 257 ESRD events and 819 deaths over a median follow-up of 5.7 and 6.5 years, respectively. In demographic adjusted models, higher levels of uNGAL were associated with increased risk of ESRD and death, but these associations were attenuated in fully adjusted models including baseline eGFR for both ESRD (hazard ratio [HR] = 1.06 per doubling, 95% confidence interval [CI] 0.98–1.14) and death (HR = 1.04, 95% CI = 1.00–1.08). Higher levels of uKIM-1 were associated with increased risk of ESRD and death in demographic-adjusted models, and although attenuated in fully adjusted models, remained statistically significant for both ESRD (HR = 1.24 per doubling, 95% CI = 1.08–1.42) and death (HR = 1.10, 95% CI =1.03–1.19). Conclusion: In this cohort of high-risk patients with baseline eGFR ≤60 ml/min per 1.73 m2 and albuminuria, renal tubular injury is associated with higher mortality and progression to ESRD. Further studies are necessary to investigate the mechanism underlying this increased risk.
AB - Introduction: Urinary neutrophil gelatinase−associated lipocalin (uNGAL) and urinary kidney injury molecule−1 (uKIM-1) are established markers of subclinical acute kidney injury. In persons with reduced estimated glomerular filtration rate (eGFR) and albuminuria who are at high risk for end-stage renal disease (ESRD) and death, the associations of these urinary markers with incident ESRD or death is an area of active investigation. Methods: Among 1472 black and white participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study with eGFR ≤60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] cystatin, 2012) and albumin-to-creatinine ratio (ACR) ≥30 mg/g, we evaluated the associations of baseline uNGAL and uKIM-1 with progression to ESRD and all-cause death. Cox models were sequentially adjusted for urinary creatinine, traditional risk factors, C-reactive protein, ACR, and eGFR. Results: There were 257 ESRD events and 819 deaths over a median follow-up of 5.7 and 6.5 years, respectively. In demographic adjusted models, higher levels of uNGAL were associated with increased risk of ESRD and death, but these associations were attenuated in fully adjusted models including baseline eGFR for both ESRD (hazard ratio [HR] = 1.06 per doubling, 95% confidence interval [CI] 0.98–1.14) and death (HR = 1.04, 95% CI = 1.00–1.08). Higher levels of uKIM-1 were associated with increased risk of ESRD and death in demographic-adjusted models, and although attenuated in fully adjusted models, remained statistically significant for both ESRD (HR = 1.24 per doubling, 95% CI = 1.08–1.42) and death (HR = 1.10, 95% CI =1.03–1.19). Conclusion: In this cohort of high-risk patients with baseline eGFR ≤60 ml/min per 1.73 m2 and albuminuria, renal tubular injury is associated with higher mortality and progression to ESRD. Further studies are necessary to investigate the mechanism underlying this increased risk.
KW - chronic kidney disease
KW - end-stage renal disease
KW - tubular injury
KW - urinary KIM-1
KW - urinary NGAL
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U2 - 10.1016/j.ekir.2018.05.013
DO - 10.1016/j.ekir.2018.05.013
M3 - Article
C2 - 30197985
AN - SCOPUS:85051022590
SN - 2468-0249
VL - 3
SP - 1183
EP - 1192
JO - Kidney International Reports
JF - Kidney International Reports
IS - 5
ER -