Randomized trial reveals improved kidney failure risk prediction with urine tubular biomarkers in adults with chronic kidney disease, indicating enhanced clinical risk assessment.
Key Points
Determine whether adding nine urine tubular biomarkers improves the prediction of kidney disease progression and treated kidney failure beyond standard clinical markers in chronic kidney disease.
Evaluated 5,100 participants with chronic kidney disease from the EMPA-KIDNEY randomized trial over a median follow-up of 3.5 years.
Measured nine creatinine-indexed tubular biomarkers and compared risk discrimination models against the Kidney Failure Risk Equation using absolute differences in Uno's C-index.
Over median 3.5 years of follow-up, 1,191 participants developed kidney disease progression and 461 experienced treated kidney failure.
Standard Kidney Failure Risk Equation models yielded a C-index of 0.858 (95% CI, 0.840–0.874) for treated kidney failure and 0.724 (95% CI, 0.705–0.743) for disease progression.
Addition of three biomarkers (MCP-1, KIM-1, and EGF) increased discrimination by an absolute C-index difference of 0.014 (95% CI, 0.009–0.024) for kidney failure and 0.038 (95% CI, 0.026–0.053) for progression, with minimal further gain from all nine.