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July 5, 2013Journal of the American Society of NephrologyOpen Access

Proteinuria and Rate of Change in Kidney Function in a Community-Based Population

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Why the study?

Does the severity of proteinuria correlate with the rate of renal decline in adults?

Population

638,150 adults from a province-wide registry in Alberta, Canada, who had a measure of proteinuria and three…

Comparison

Proteinuria of varying severity (mild and heavy) vs Normal proteinuria

Design

Cohort

Follow-up

≥1 year

Key result

Proteinuria of increasing severity was associated with a faster rate of renal decline regardless of baseline eGFR, with heavy proteinuria in men with baseline eGFR 45-59.9 correlating with an eGFR decline of 2.16 ml/min/1.73m2 per year.

Authors

TTTanvir Chowdhury TurinMJMatthew T. JamesPRPietro Ravani

Discussion

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Overview

May refine CKD prognosis beyond eGFR; extends observational data but leaves causal effects and interventions open.

Study Design

Type

Cohort (n=638,150)

Structured PICO

Does the severity of proteinuria correlate with the rate of renal decline in adults?

P
Population
638,150 adults in Alberta, Canada, with at least three outpatient serum creatinine measurements over ≥1 year and a measure of proteinuria, followed for a median of 4.4 years.
E
Exposure
Proteinuria of varying severity (mild and heavy)
C
Comparator
Normal proteinuria
O
Outcome
Rate of change in estimated GFR (eGFR) per yearsurrogate

Main Result

Effect estimate: Change in eGFR of -2.16 ml/min per 1.73 m2 per year (95% CI -2.37 to -1.95)

Proteinuria of increasing severity is associated with a faster rate of renal decline regardless of baseline eGFR, emphasizing the need to assess both parameters in patients with CKD.

Limitations

  • Observational study design limits causal inference
  • Cohort was limited to individuals who had at least three outpatient serum creatinine measurements, excluding those who did not use medical services
  • Lack of information on the physician who ordered the serum creatinine measurement or the indications
  • Potential laboratory drift over time
  • Estimation of the change in eGFR could have been affected by the baseline eGFR due to regression to the mean
  • Inability to adjust for BP control, cause of kidney disease, smoking habit, lipid control, or drug use (e.g., RAS blockers)

Cite This Study

Turin et al. (2013) conducted a cohort in Chronic kidney disease (n=638,150). Proteinuria vs. Normal protein levels was evaluated on Rate of change in estimated GFR (eGFR) per year (Change in eGFR of -2.16 ml/min per 1.73 m2 per year, 95% CI -2.37 to -1.95). Proteinuria of increasing severity was associated with a faster rate of renal decline regardless of baseline eGFR, with heavy proteinuria in men with baseline eGFR 45-59.9 correlating with an eGFR decline of 2.16 ml/min/1.73m2 per year.

synapsesocial.com/papers/6a97c05f57c1a2673676fbd8https://doi.org/10.1681/asn.2012111118
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Also Consider

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

  1. 1Associations among Estimated Glomerular Filtration Rate, Proteinuria, and Adverse Cardiovascular Outcomes2011 · 154 citations
  2. 2The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease2005 · 298 citations
  3. 3Blood Pressure, Proteinuria, and Renal Function Decline: Associations in a Large Community-Based Population2015 · 67 citations
  4. 4Proteinuria and Kidney Function Trajectories in Patients with Advanced CKD2026
  5. 5Prognostic Impact of Proteinuria at Manifestation in Adult Nephrotic Syndrome Patients: Insights from a Prospective Cohort Study2024 · 1 citations