Kidney Week

Abstract: TH-PO1024

Associations of Proteinuria Trajectories with Kidney Failure and Death in Patients with CKD

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Aronov, Avi G., University of Illinois Chicago, Chicago, Illinois, United States

Avi G. Aronov, MD

• Verma, Ashish, Boston Medical Center, Boston, Massachusetts, United States

Ashish Verma, MBBS, FASN

• Ricardo, Ana C., University of Illinois Chicago, Chicago, Illinois, United States

Ana C. Ricardo, MD, MS, MPH, FASN

• Kelly, Tanika, University of Illinois Chicago, Chicago, Illinois, United States

Tanika Kelly, PhD, MPH

• Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States

Sushrut S. Waikar, MD, MPH

• Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States

James P. Lash, MD, FASN

• Srivastava, Anand, University of Illinois Chicago, Chicago, Illinois, United States

Anand Srivastava, MD, MPH

Group or Team Name

• CRIC Study.

Background

Despite repeating proteinuria measurements multiple times during the clinical course of a patient with chronic kidney disease (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) (Figure 1A). 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 (Figure 1B).

Conclusion

Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD that have increased risks of ESKD and death independent of known risk factors.

Funding

• NIDDK Support