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Abstract: FR-PO916

Plasma Proneurotensin and Kidney Outcomes in REGARDS

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Bullen, Alexander L., University of California San Diego, La Jolla, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Cushman, Mary, University of Vermont, Burlington, Vermont, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
  • Rifkin, Dena E., VA San Diego Healthcare System, San Diego, California, United States
Background

Chronic kidney disease is common, costly and it is associated with cardiovascular disease and increased mortality. Early identification of CKD is imperative to prevent progression and potentially reduce cardiovascular morbidity and mortality. Plasma proneurotensin (ProNT) is a precursor of neurotensin (NT). NT and its related peptides have been linked to risk for disease processes related to kidney disease, including cardiovascular disease, and type 2 diabetes mellitus. It is unknown whether ProNT is directly associated with incident CKD.

Methods

Among 3914 participants who were part of BioMedioR, a nested cohort within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) who completed the second visit, we measured ProNT by Sphingotest (double monoclonal sandwich immunoassay). Primary outcomes were significant eGFR decline (defined as 30% decline), incident albuminuria (defined as albumin/creatinine greater or equal to 30 at second visit) and incident CKD (defined as eGFR less than 60 mL/min/1.73m2 plus 40% decline in eGFR). Logistic regression with inverse probability sampling weights for analysis. Sequential models adjusted for age sex, and race (Model 1); BMI, SBP, DBP, diabetes, smoking, cholesterol and prevalent CVD (Model 2); and baseline eGFR and albuminuria (Model 3). Using model 3, we tested for interaction ProNT and race and explored analyses by race. We used similar models to evaluate for incident albuminuria, excluding albuminuria in model 3.

Results

Higher ProNT levels were associated with greater eGFR decline among all participants independent of baseline eGFR and albuminuria (OR: 1.12, 95% CI [1.00, 1.26]) and incident albuminuria (OR: 1.31, 95% CI 1.14,1.50). Higher ProNT levels were also associated with greater incidence of CKD; however, this association was attenuated after including baseline eGFR and albuminuria (OR: 1.25, 95% CI 0.98, 1.59). We did not find any interactions between ProNT and race or sex in any of the three outcomes.

Conclusion

Assessment of ProNT provides information about significant eGFR decline and incident albuminuria but not incident CKD among persons at high risk of hypertension and diabetes, known risk factors of incidence and progression of CKD. These associations were independent of race or sex. Further studies should evaluate if ProNT can help tailor treatments to slow progression of CKD in a high-risk population.

Funding

  • Veterans Affairs Support