Kidney Week

Abstract: SA-PO764

CKD Without Significant Proteinuria—Is It Possible to Predict Faster Decline in eGFR?

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

Author

• Tanaka, Hiroshi, Mihara Red Cross Hospital, Mihara, Hiroshima, Japan

Hiroshi Tanaka,

Background

CKD patients without significant proteinuria have been recognized that they tend to have slower eGFR decline than proteinuric CKD patients have. However substantial population of those patients eventually reach ESRF. The aim of this study is to elucidate risk factors for progressive decline in eGFR in patients without significant proteinuria.

Methods

A hospital-wide survey included a whole set of laboratory tests over 24 months. Patients with at least 3 measurements of eGFR over 365 days or more, with an averaged eGFR of less than 50mL/min/1.73m² were collected. An eGFR slope was calculated for each patient. For the assessment of proteinuria, a dipstick urine protein determination was considered to better represent the real-world clinics for all the subspecialities in the Hospital; numbers of 0, 0.5, 1, 2, 3 or 4 were applied to (-), (+-), (1+), (2+), (3+) or (4+) respectively, then the numbers were averaged during the study period (avUprot); an excellent relation between avUprot and averaged U-protein/U-creatinine ratio has been previously confirmed in a different cohort (Up/Ucr = -0.346 + 1.185*avUprot, n=1,379; p<0.0001). Patients with avUprot less than 1.0 comprised the final cohort for this study. All the laboratory values such as serum albumin were equally averaged during the study period for each patient.

Results

Among the total 40,797 patients with laboratory examination, the final cohort included 1,174 patients (M:F 581:593, age 32-95 (median 77)), with eGFR 5.8-49.9 (41.3) mL/min/1.73m² and avUprot 0.00-0.96 (0.14) g/g Cr. In a univariate analysis, the eGFR slope was associated with age, plasma ALT (alanine aminotransferase), serum Na and serum albumin. In a multivariate stepwise analysis, the eGFR slope was correlated with ALT, serum Na and serum albumin. In a 3x3 table where the cohort was divided into tertiles for ALT and serum albumin, patients with the lowest tertile of serum albumin (1.70-3.87 g/dL) combined with the highest tertile of ALT (22.0-265.4 IU/L) had the fastest eGFR decline (-4.07+-9.11 (median -2.44) mL/min/1.73m²/yr) among the 9 divisions, with an OR 2.13 for the fastest-eGFR-slope tertile (-2.47 mL/min/1.73m²/yr or below) against the sum of the remaining 8 divisions as a reference.

Conclusion

Combination of serum albumin and ALT might serve as a simple measure to predict progressive decline in eGFR in the CKD patients with minimal or no proteinuria.