Key result
Mild proteinuria is linked to a ~70% higher rate of RRT initiation versus no proteinuria.
Why the study?
Proteinuria is a risk marker for CKD progression and ACEi/ARB treatment is beneficial, but their roles in patients on specialized predialysis care are not well known.
Does ACEi/ARB treatment and proteinuria level predict renal function decline and the start of renal replacement therapy in predialysis CKD patients?
Cohort (n=547)
Yes
Does ACEi/ARB treatment and proteinuria level predict renal function decline and the start of renal replacement therapy in predialysis CKD patients?
Hazard Ratio: 1.7 (95% CI 1.05–2.77)
Proteinuria is a strong risk marker for CKD progression in predialysis patients, and ACEi/ARB use in this advanced CKD population does not appear deleterious and may delay the need for renal replacement therapy.
Proteinuria predicts faster RFD and earlier RRT in predialysis CKD; leaves open whether ACEi/ARB alters these outcomes.
BACKGROUND/AIMS: Proteinuria is a risk marker for progression of chronic kidney disease (CKD) and treatment with an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEi/ARB) is beneficial in these patients. However, little is known about proteinuria and ACEi/ARB treatment in patients on specialized predialysis care. Therefore, we investigated the association of urinary protein excretion (UPE) and ACEi/ARB treatment with renal function decline (RFD) and/or the start of renal replacement therapy (RRT) in patients on predialysis care. METHODS: In the PREPARE-1 cohort, 547 incident predialysis patients (CKD stages IV-V), referred as part of the usual care to outpatient clinics of eight Dutch hospitals, were included (1999-2001) and followed until the start of RRT, mortality, or January 1, 2008. The main outcomes were rate of RFD, estimated as the slope of available eGFR measurements, and the start of RRT. RESULTS: Patients with mild proteinuria (>0.3 to ≤1.0 g/24 h) had an adjusted additional RFD of 0.35 ml/min/1.73 m(2)/month (95% CI: 0.01; 0.68) and a higher rate of starting RRT [adjusted HR: 1.70 (1.05; 2.77)] compared with patients without proteinuria (≤0.3 g/24 h). With every consecutive UPE category (>1.0 to ≤3.0, >3.0 to ≤6.0, and >6.0 g/24 h), RFD accelerated and the start of RRT was earlier. Furthermore, patients starting (n = 16) or continuing (n = 133) treatment with ACEi/ARBs during predialysis care had a lower rate of starting RRT compared with patients not using treatment [n = 152, adjusted HR: 0.56 (0.29; 1.08) and 0.90 (0.68; 1.20), respectively]. CONCLUSION: In patients on predialysis care, we confirmed that proteinuria is a risk marker for the progression of CKD. Furthermore, no evidence was present that the use of ACEi/ARBs is deleterious.
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Goeij et al. (2012) conducted a cohort in Chronic Kidney Disease (CKD stages IV-V) (n=547). Mild proteinuria (>0.3 to ≤1.0 g/24 h) vs. No proteinuria (≤0.3 g/24 h) was evaluated on Rate of renal function decline and the start of renal replacement therapy (RRT) (HR 1.70, 95% CI 1.05-2.77). Mild proteinuria (>0.3 to ≤1.0 g/24 h) was associated with a higher rate of starting renal replacement therapy compared to no proteinuria (HR 1.70; 95% CI 1.05-2.77).
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