Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria

Background: Proteinuria predicts poor renal and cardiovascular outcomes. Some guidelines recommend measuring proteinuria using albumin:creatinine ratio (ACR), while others recommend total protein:creatinine ratio (TPCR). Aim: To compare renal outcomes and mortality in the populations identified by t...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2011-08, Vol.104 (8), p.663-670
Main Authors: Methven, S., Traynor, J.P., Hair, M.D., O'Reilly, D. St J., Deighan, C.J., MacGregor, M.S.
Format: Article
Language:English
Subjects:
Adult
Aged
Albuminuria - diagnosis
Albuminuria - etiology
Albuminuria - urine
Biological and medical sciences
Biomarkers - urine
Cohort Studies
Creatinine - urine
Dose-Response Relationship, Drug
Female
General aspects
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Kidney Failure, Chronic - urine
Kidneys
Longitudinal Studies
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Practice Guidelines as Topic
Proportional Hazards Models
Proteinuria - diagnosis
Proteinuria - etiology
Proteinuria - urine
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Urinary system involvement in other diseases. Miscellaneous
Urinary tract. Prostate gland
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Summary:Background: Proteinuria predicts poor renal and cardiovascular outcomes. Some guidelines recommend measuring proteinuria using albumin:creatinine ratio (ACR), while others recommend total protein:creatinine ratio (TPCR). Aim: To compare renal outcomes and mortality in the populations identified by these different recommendations. Design: Retrospective longitudinal cohort study. Methods: Baseline ACR and TPCR measurements were obtained from 5586 patients with chronic kidney disease (CKD) attending a Scottish hospital nephrology clinic. The cohort was divided into three groups with concordant results by ACR and TPCR (no proteinuria; low proteinuria; significant proteinuria) and one group with discordant results (significant proteinuria with TPCR, but not ACR). Outcomes were assessed using Kaplan-Meier plots and Cox proportional hazards models. Results: Median follow-up was 3.5 years [interquartile range (IQR) 2.1-6.0]; 844 (15%) died at 3.0 years (IQR 1.8-4.7) and 468 (8%) started renal replacement therapy (RRT) at 1.7 years (IQR 0.6-3.4). Proteinuria was associated with a substantially increased risk of RRT and death. Patients with significant proteinuria by TPCR, but not ACR (n = 231) had high renal risk, and the highest all-cause mortality (log-rank P 
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/hcr026