Avi G Aronov, Ashish Verma, Ana C Ricardo, Tanika N Kelly, Sushrut S Waikar, James P Lash, Anand Srivastava
{"title":"蛋白尿轨迹与CKD患者肾功能衰竭和死亡的关系","authors":"Avi G Aronov, Ashish Verma, Ana C Ricardo, Tanika N Kelly, Sushrut S Waikar, James P Lash, Anand Srivastava","doi":"10.34067/KID.0000000849","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify sub-populations with varying risks of adverse clinical outcomes.</p><p><strong>Methods: </strong>We used group-based trajectory modeling to identify proteinuria trajectories based on annual urine protein-to-creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort Study who were alive and did not reach end-stage kidney disease (ESKD) within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the 3rd annual visit.</p><p><strong>Results: </strong>Trajectory analyses identified 4 discrete groups based on annual UPCR measurements: low-slowly rising (n=1528), high-slowly rising (n=1363), regressing (n=114), and rapidly rising (n=204). Compared to the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared to the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.</p><p><strong>Conclusions: </strong>Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations of Proteinuria Trajectories with Kidney Failure and Death in Individuals with CKD.\",\"authors\":\"Avi G Aronov, Ashish Verma, Ana C Ricardo, Tanika N Kelly, Sushrut S Waikar, James P Lash, Anand Srivastava\",\"doi\":\"10.34067/KID.0000000849\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify sub-populations with varying risks of adverse clinical outcomes.</p><p><strong>Methods: </strong>We used group-based trajectory modeling to identify proteinuria trajectories based on annual urine protein-to-creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort Study who were alive and did not reach end-stage kidney disease (ESKD) within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the 3rd annual visit.</p><p><strong>Results: </strong>Trajectory analyses identified 4 discrete groups based on annual UPCR measurements: low-slowly rising (n=1528), high-slowly rising (n=1363), regressing (n=114), and rapidly rising (n=204). Compared to the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared to the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.</p><p><strong>Conclusions: </strong>Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.</p>\",\"PeriodicalId\":17882,\"journal\":{\"name\":\"Kidney360\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.34067/KID.0000000849\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.34067/KID.0000000849","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Associations of Proteinuria Trajectories with Kidney Failure and Death in Individuals with CKD.
Background: Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify sub-populations with varying risks of adverse clinical outcomes.
Methods: We used group-based trajectory modeling to identify proteinuria trajectories based on annual urine protein-to-creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort Study who were alive and did not reach end-stage kidney disease (ESKD) within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the 3rd annual visit.
Results: Trajectory analyses identified 4 discrete groups based on annual UPCR measurements: low-slowly rising (n=1528), high-slowly rising (n=1363), regressing (n=114), and rapidly rising (n=204). Compared to the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared to the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.
Conclusions: Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.