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February 25, 2022PLoS ONEOpen Access

Low-grade proteinuria and atherosclerotic cardiovascular disease: A transition study of patients with diabetic kidney disease

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Key result

In incident hemodialysis patients with diabetes, the lowest quartile of proteinuria (<3.0 g/gCr) was associated with a greater risk of atherosclerotic cardiovascular disease compared to the third quartile (SHR 2.04).

Why the study?

The clinical implications of proteinuria levels at the start of dialysis have not been confirmed in patients with diabetic kidney disease.

Does lower proteinuria at dialysis initiation predict atherosclerotic cardiovascular disease in incident hemodialysis patients with diabetes?

Population

361 incident hemodialysis patients with diabetes

Comparison

Proteinuria quartiles at dialysis initiation

Design

Retrospective multicenter cohort study

Authors

SYSatoshi YamaguchiTHTakayuki HamanoTOTatsufumi Oka

Discussion

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Member takes

Overview

May warrant closer ASCVD monitoring in low-proteinuria diabetic HD patients; leaves open whether it refines risk stratification.

Study Design

Type

Cohort (n=361)

Multicenter

Yes

Structured PICO

Does lower proteinuria at dialysis initiation predict atherosclerotic cardiovascular disease in incident hemodialysis patients with diabetes?

P
Population
361 incident hemodialysis patients with diabetes, with a mean age of 66 years and 27% female, followed for a median of 36 months.
E
Exposure
Lower quartile of proteinuria (urine protein-to-creatinine ratio < 3.0 g/gCr)
C
Comparator
Higher quartiles of proteinuria (urine protein-to-creatinine ratio 5.4-8.8 g/gCr or >8.8 g/gCr)
O
Outcome
Fatal atherosclerotic CVD and re-hospitalization for atherosclerotic CVDhard clinical

Main Result

Hazard Ratio: 2.04 (95% CI 1–4.14)

p-value: p=0.049

In incident hemodialysis patients with diabetes, lower proteinuria at dialysis initiation is associated with a higher risk of atherosclerotic cardiovascular disease, reflecting more severe underlying macroangiopathy.

Limitations

  • Outcomes were not adjudicated, and indications for hospitalization might vary among physicians
  • Enrolled only patients with diabetes, so results cannot be extrapolated to patients without diabetes
  • Method of measuring renal length was not standardized among the technicians
  • Cannot prove causality
  • Retrospective design

Cite This Study

Yamaguchi et al. (2022) conducted a cohort in Diabetic kidney disease (n=361). Lowest quartile of proteinuria (<3.0 g/gCr) vs. Third quartile of proteinuria (5.4-8.8 g/gCr) was evaluated on Fatal atherosclerotic CVD and re-hospitalization for atherosclerotic CVD (SHR 2.04, 95% CI 1.00-4.14, p=0.049). In incident hemodialysis patients with diabetes, the lowest quartile of proteinuria (<3.0 g/gCr) was associated with a greater risk of atherosclerotic cardiovascular disease compared to the third quartile (SHR 2.04).

synapsesocial.com/papers/6a96d7622d8f86faeeb2f978https://doi.org/10.1371/journal.pone.0264568
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies2018 · 91 citations
  2. 2Proteinuria as a Marker for Cardiovascular Disease in Renal (Chronic Kidney Disease) Patients2018 · 1 citations
  3. 3Proteinuria and its relation to cardiovascular disease2013 · 142 citations
  4. 4Associations among Estimated Glomerular Filtration Rate, Proteinuria, and Adverse Cardiovascular Outcomes2011 · 154 citations
  5. 5Comparison of Renal Function Decline in Proteinuric and Non-Proteinuric Diabetic Kidney Disease: A Retrospective Single-Centre Study2026