What does this research mean for the field?

Higher urine protein-to-creatinine ratio (UPCR) levels are strongly associated with accelerated chronic kidney disease (CKD) progression and a shorter projected time to reach kidney failure in patients with advanced CKD. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To examine the association between urine protein-to-creatinine ratio and the rates of kidney function decline and projected time to kidney failure in patients with advanced chronic kidney disease.

August 29, 2026Clinical Journal of the American Society of Nephrology

Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD

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Authors

CPCheol Ho ParkGeneral / Preventive / Lipids HHHyun Jun HongYonsei University HKHyung Woo KimIndian Institute of Technology Guwahati

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Implication

Cohort study reveals higher urine protein-to-creatinine ratios accelerate kidney function decline in advanced chronic kidney disease, indicating its strong prognostic utility for kidney failure.

Key Points

To examine the association between urine protein-to-creatinine ratio and the rates of kidney function decline and projected time to kidney failure in patients with advanced chronic kidney disease.
Analyzed 2,727 participants with eGFR 15–45 mL/min/1.73 m² not receiving kidney replacement therapy from the CRIC and KNOW-CKD cohort studies over a median follow-up of 4.9 years (17,069 person-years).
Evaluated baseline and time-updated urine protein-to-creatinine ratio (UPCR) categories (<0.5, 0.5–1.0, 1.0–3.0, and ≥3.0 g/gCr) against primary CKD progression (≥50% eGFR decline or initiation of kidney replacement therapy), eGFR slopes, and time to reach an eGFR threshold of 10 mL/min/1.73 m².
Primary outcome occurred in 1,474 participants (54%), with baseline UPCR categories of 0.5–1.0, 1.0–3.0, and ≥3.0 g/gCr showing hazard ratios of 2.08 (95% CI, 1.76–2.45), 3.05 (95% CI, 2.64–3.52), and 6.32 (95% CI, 5.24–7.61), respectively, compared to UPCR <0.5 g/gCr.
Time-updated UPCR exhibited a stronger association with primary CKD progression, with hazard ratios of 2.58 (95% CI, 2.13–3.12), 5.61 (95% CI, 4.76–6.62), and 12.88 (95% CI, 10.58–15.67) across increasing categories.
Annual eGFR slope steepened from -0.87 to -5.45 mL/min/1.73 m² per year across UPCR categories, while projected time to the kidney failure eGFR threshold dropped progressively from 28.7 years (95% CI, 25.6–32.6) to 3.8 years (95% CI, 3.5–4.2).

Cite This Study

Park et al. (2026) studied this question.

synapsesocial.com/papers/6a92be7b8e5d7d1fc0c122b5 https://doi.org/10.2215/cjn.0000001206

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Implication

Cohort study reveals higher urine protein-to-creatinine ratios accelerate kidney function decline in advanced chronic kidney disease, indicating its strong prognostic utility for kidney failure.

Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD

Discussion

Member takes

Implication

Key Points

Cite This Study

Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD

Discussion

Member takes

Implication

Key Points

Cite This Study

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