Epidemiology of low-proteinuric chronic kidney disease in renal clinicsReport as inadecuate

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CKD patients with low-grade proteinuria LP are common in nephrology clinics. However, prevalence, characteristics, and the competing risks of ESRD and death as the specific determinants, are still unknown. We analyzed epidemiological features of LP status in a prospective cohort of 2,340 patients with CKD stage III-V referred from ≥6 months in 40 nephrology clinics in Italy. LP status was defined as proteinuria <0.5 g-24h according to current KDIGO guidelines. Patients with higher proteinuria constituted the control group CON. LP patients were 54.5% of the whole cohort. As compared to CON, LP were older 70.0±12.1 vs 65.4±14.1 y, and less likely to be male 55.8 vs 62.0% and diabetic 27.6 vs 34.1%, and had hypertension as the most common cause of CKD 39.8%. They had higher eGFR 34.8±13.5 vs 26.8±13.2 mL-min-1.73m2 and hemoglobin 12.7±1.7 vs 12.3±1.7 g-dL, while systolic blood pressure 137±18 vs 140±18 mmHg and serum phosphorus 3.7±0.8 vs 3.9±0.8 mg-dL were lower P<0.001 for all comparisons. Over a median follow-up of 48 months, an inverse relative risk of ESRD and death was observed in LP death>>ESRD; P = 0.002 versus CON ESRD>>death; P<0.0001. Modifiable risk factors were also different in LP, with smoking, lower hemoglobin, and proteinuria being associated with higher mortality risk while lower BMI and higher phosphorus predicting ESRD at multivariable Cox analyses P<0.05 for all. Therefore, in nephrology clinics, LP patients are the majority and show distinctive basal features. More important, they are more exposed to death than ESRD and do present specific modifiable determinants of either outcome; indeed, in LP, while smoking plays a role for mortality, lower BMI and higher phosphorus levels -even if in the normal range- are predictors of ESRD. These data support the need to further study the low proteinuric CKD population to guide management.

Author: Luca De Nicola , Michele Provenzano, Paolo Chiodini, Silvio Borrelli, Luigi Russo, Antonio Bellasi, Domenico Santoro, Giuseppe Co

Source: http://plos.srce.hr/


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