Abstract: SA-PO750
Even Low-Grade Proteinuria Increases Progression to Renal End-Points in Non-Diabetic Hypertensive Veterans
Session Information
- CKD: Epidemiology, Risk Factors, Prevention - III
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Oni, Olurinde, KCVA Medical Center, Kansas City, Missouri, United States
- Savin, Virginia J., KCVA Medical Center, Kansas City, Missouri, United States
- Sharma, Mukut, KCVA Medical Center, Kansas City, Missouri, United States
- Sharma, Ram, KCVA Medical Center, Kansas City, Missouri, United States
- Wiegmann, Thomas, KCVA Medical Center, Kansas City, Missouri, United States
- Barua, Rajat S., KCVA Medical Center, Kansas City, Missouri, United States
- Sharma, Rishi, Univ. of Missouri Kansas City, Kansas City, Missouri, United States
Background
Proteinuria is an indicator of renal injury but there is little quantitative information about the predictive value of low concentrations of urine protein in patients without diabetes. We hypothesized that incremental risk would accrue with increasing proteinuria in hypertensive, non-diabetic patients.
Methods
A cohort of 153,848 hypertensive non-diabetic patients in the VA national database (VINCI) and recorded urinalysis was categorized as 'no proteinuria' or by first recorded urine protein (dip-stick: ≤30, 31-100, and >100 mg/dl) and by CKD stage. Endpoints included ESRD and all-cause mortality. Baseline characteristics were compared using ANOVA, Chi square tests and non-parametric tests. Adjusted Cox regression, and Kaplan Meier analyses were conducted to compare risks.
Results
Proteinuric groups had accelerated progression to ESRD and combined renal endpoint, and had increased all-cause mortality (Logrank P<0.01). Proteinuria < 30 mg/dl was associated with renal endpoint and had a relatively smaller effect than higher grades proteinuria. Younger age, higher CKD stage, prior diagnosis of AKI, or use of ACEI, ARB or β-blocker at first proteinuria were associated with higher risk of progression and all-cause mortality.
Conclusion
We conclude that, in non-diabetic Veterans with hypertension, even low concentrations of proteinuria predict renal failure and mortality and should not be ignored. Early identification of proteinuria as a risk will permit research regarding novel mechanisms of progression and may define interventions to delay progression and lower mortality.
Adjusted Hazard ratios for Renal Endpoints
| Proteinuria group (ref=no protein) | ESRD HR (CI) | Mortality HR (CI) | Composite¥ HR (CI) |
| <=30mg/dl | 3.8 (3.4-4.2) | 1.6 (1.5-1.7) | 1.6 (1.5-1.7) |
| 31-100mg/dl | 4.6 (4.1-5.2) | 1.7 (1.6-1.8) | 1.7 (1.6-1.8) |
| >100mg/dl | 4.7 (4.1-5.5) | 1.6 (1.5-1.7) | 1.6 (1.5-1.8) |
¥ ESRD, mortality, or dialysis. All P values <0.01. Mean BMI=28.6; mean age=66.1 years. Covariates not shown.
Funding
- Veterans Affairs Support