Disease Progression, Clinical Outcomes and Treatment Challenges in Patients with Chronic Kidney Disease and High-Risk Proteinuria.

IF 4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-09-15 DOI:10.1007/s12325-025-03364-8

Roberto Pecoits-Filho, Johan Bodegård, Phil Ambery, You-Seon Nam, Marcus Thuresson, Maria K Svensson

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引用次数: 0

Abstract

Introduction: A urine albumin-creatinine ratio (UACR) > 700 mg/g signifies severe kidney damage, and nephrology referral is recommended for intensified management. The impact of UACR ≥ 700 mg/g on outcomes and the efficacy of kidney protective therapies in patients have not been thoroughly examined.

Methods: Using claims healthcare data from the USA, we identified prevalent patients with chronic kidney disease and a UACR measurement on 1 January 2022, and grouped them by UACR level. We also identified new users of sodium-glucose cotransporter 2 inhibitors (SGLT2i) between 2021 and 2023. Outcomes included estimated glomerular filtration rate (eGFR) slopes and risks of adverse outcomes and mortality.

Results: Of the 46,626 patients with UACR ≥ 300 mg/g, 23,998 had UACR ≥ 700 mg/g. In the UACR ≥ 700 and UACR 300 to < 700 mg/g groups, mean age was 72 and 74 years, median eGFR was 42 and 50 mL/min/1.73 m², median UACR was 1376 and 437 mg/g at baseline and eGFR slopes were - 5.5 and - 3.1 mL/min/1.73 m² per year, respectively. Compared to the UACR < 10 mg/g group, adjusted hazard ratio of risk of cardiorenal hospitalizations was 5.83 (95% CI 5.55-6.12) and 3.53 (95% CI 3.34-3.73), atherosclerotic cardiovascular disease hospitalizations was 2.97 (95% CI 2.76-3.19) and 2.33 (95% CI 2.15-2.52), and all-cause death was 2.89 (95% CI 2.78-3.02) and 2.10 (95% CI 2.01-2.20) in the UACR ≥ 700 and UACR 300 to < 700 mg/g groups, respectively. Of the 5908 new users of SGLT2i with UACR ≥ 700 mg/g, UACR and eGFR slope improved as expected (to 720 mg/g and - 2.44 mL/min/1.73 m² per year, respectively).

Conclusions: A UACR ≥ 700 mg/g identifies patients at high risk of accelerated kidney function decline and adverse outcomes. While emerging therapies such as SGLT2i had the expected benefits, the persistence of residual proteinuria/albuminuria and associated risks highlight an unmet need for optimized and new treatment strategies.

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慢性肾病和高危蛋白尿患者的疾病进展、临床结果和治疗挑战

尿白蛋白-肌酐比值（UACR）为700 mg/g，提示严重肾损害，建议转诊肾内科加强治疗。UACR≥700mg /g对患者预后和肾保护治疗效果的影响尚未得到彻底研究。方法：使用来自美国的索赔医疗数据，我们确定了2022年1月1日的慢性肾脏疾病流行患者和UACR测量，并按UACR水平对其进行分组。我们还确定了2021年至2023年间钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）的新用户。结果包括估计的肾小球滤过率（eGFR）斜率、不良结局和死亡率的风险。结果：在46,626例UACR≥300 mg/g的患者中，23,998例UACR≥700 mg/g。在UACR≥700和UACR 300 ~ 2时，基线时的中位UACR分别为1376和437 mg/g， eGFR斜率分别为- 5.5和- 3.1 mL/min/1.73 m2 /年。与UACR相比，分别为每年2个)。结论：UACR≥700mg /g表明患者存在肾功能加速下降和不良结局的高风险。虽然SGLT2i等新兴疗法具有预期的益处，但残留蛋白尿/白蛋白尿的持续存在及其相关风险突出了对优化和新治疗策略的需求未得到满足。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.