Loading…
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...
Saved in:
| Published in: | QJM : An International Journal of Medicine 2011-08, Vol.104 (8), p.663-670 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3 |
| container_end_page | 670 |
| container_issue | 8 |
| container_start_page | 663 |
| container_title | QJM : An International Journal of Medicine |
| container_volume | 104 |
| creator | Methven, S. Traynor, J.P. Hair, M.D. O'Reilly, D. St J. Deighan, C.J. MacGregor, M.S. |
| description | 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 |
| doi_str_mv | 10.1093/qjmed/hcr026 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_878279654</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/qjmed/hcr026</oup_id><sourcerecordid>878279654</sourcerecordid><originalsourceid>FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3</originalsourceid><addsrcrecordid>eNp9kL1v2zAQxYmgRZ2PbpkLLkWXOCEpihS7BUHSFgnQIcksUOQxoS2RDikV8Nx_vHRsw1unu3v43bvDQ-ickktKVHX1thjAXr2aRJg4QseUCzJnlao-7HvJ6hk6yXlBCOGSN5_QjNGqYYrxY_T3cUx69G7twwtOPi-xD9i8phi8wUtvA6yx9Rl0hu9YBxy7DOlP2YhB9ziPk13j6PDzPX6ZvIXeB8jYxYSHsjKljesYx4KuUhzBhyLp4mOx7rtp2M5n6KPTfYbPu3qKnu9un25-zh9-__h1c_0wN7wW45zXHXAuOlBECyWcZcRKpiWVyjFpZKWosJ0F0YnC8VpxKog2tIO6YU5BdYq-bX3LL28T5LEdfDbQ9zpAnHLbyIZJJWpeyIstaVLMOYFrV8kPOq1bStpN6u176u029YJ_2RlP3Ubew_uYC_B1B-hsdO-SDsbnA8erpmGUHD6M0-r_J_8ByZScSg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>878279654</pqid></control><display><type>article</type><title>Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria</title><source>Oxford Journals Online</source><creator>Methven, S. ; Traynor, J.P. ; Hair, M.D. ; O'Reilly, D. St J. ; Deighan, C.J. ; MacGregor, M.S.</creator><creatorcontrib>Methven, S. ; Traynor, J.P. ; Hair, M.D. ; O'Reilly, D. St J. ; Deighan, C.J. ; MacGregor, M.S.</creatorcontrib><description>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 < 0.001). With multivariate analysis the risk fell below those with significant proteinuria with concordant results by ACR and TPCR but remained considerably higher than those without significant proteinuria.
Conclusions: Proteinuria screening with TPCR identifies an additional 16% of patients with significant proteinuria, not identified using ACR. This subgroup has high renal risk, and high risk of all-cause mortality and therefore warrant identification. Guideline recommendations on proteinuria screening in CKD should be reconsidered.</description><identifier>ISSN: 1460-2725</identifier><identifier>EISSN: 1460-2393</identifier><identifier>DOI: 10.1093/qjmed/hcr026</identifier><identifier>PMID: 21382924</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>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</subject><ispartof>QJM : An International Journal of Medicine, 2011-08, Vol.104 (8), p.663-670</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3</citedby><cites>FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24388210$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21382924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Methven, S.</creatorcontrib><creatorcontrib>Traynor, J.P.</creatorcontrib><creatorcontrib>Hair, M.D.</creatorcontrib><creatorcontrib>O'Reilly, D. St J.</creatorcontrib><creatorcontrib>Deighan, C.J.</creatorcontrib><creatorcontrib>MacGregor, M.S.</creatorcontrib><title>Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria</title><title>QJM : An International Journal of Medicine</title><addtitle>QJM</addtitle><description>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 < 0.001). With multivariate analysis the risk fell below those with significant proteinuria with concordant results by ACR and TPCR but remained considerably higher than those without significant proteinuria.
Conclusions: Proteinuria screening with TPCR identifies an additional 16% of patients with significant proteinuria, not identified using ACR. This subgroup has high renal risk, and high risk of all-cause mortality and therefore warrant identification. Guideline recommendations on proteinuria screening in CKD should be reconsidered.</description><subject>Adult</subject><subject>Aged</subject><subject>Albuminuria - diagnosis</subject><subject>Albuminuria - etiology</subject><subject>Albuminuria - urine</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - urine</subject><subject>Cohort Studies</subject><subject>Creatinine - urine</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidney Failure, Chronic - urine</subject><subject>Kidneys</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Practice Guidelines as Topic</subject><subject>Proportional Hazards Models</subject><subject>Proteinuria - diagnosis</subject><subject>Proteinuria - etiology</subject><subject>Proteinuria - urine</subject><subject>Renal Replacement Therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><issn>1460-2725</issn><issn>1460-2393</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp9kL1v2zAQxYmgRZ2PbpkLLkWXOCEpihS7BUHSFgnQIcksUOQxoS2RDikV8Nx_vHRsw1unu3v43bvDQ-ickktKVHX1thjAXr2aRJg4QseUCzJnlao-7HvJ6hk6yXlBCOGSN5_QjNGqYYrxY_T3cUx69G7twwtOPi-xD9i8phi8wUtvA6yx9Rl0hu9YBxy7DOlP2YhB9ziPk13j6PDzPX6ZvIXeB8jYxYSHsjKljesYx4KuUhzBhyLp4mOx7rtp2M5n6KPTfYbPu3qKnu9un25-zh9-__h1c_0wN7wW45zXHXAuOlBECyWcZcRKpiWVyjFpZKWosJ0F0YnC8VpxKog2tIO6YU5BdYq-bX3LL28T5LEdfDbQ9zpAnHLbyIZJJWpeyIstaVLMOYFrV8kPOq1bStpN6u176u029YJ_2RlP3Ubew_uYC_B1B-hsdO-SDsbnA8erpmGUHD6M0-r_J_8ByZScSg</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>Methven, S.</creator><creator>Traynor, J.P.</creator><creator>Hair, M.D.</creator><creator>O'Reilly, D. St J.</creator><creator>Deighan, C.J.</creator><creator>MacGregor, M.S.</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110801</creationdate><title>Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria</title><author>Methven, S. ; Traynor, J.P. ; Hair, M.D. ; O'Reilly, D. St J. ; Deighan, C.J. ; MacGregor, M.S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Albuminuria - diagnosis</topic><topic>Albuminuria - etiology</topic><topic>Albuminuria - urine</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - urine</topic><topic>Cohort Studies</topic><topic>Creatinine - urine</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Failure, Chronic - complications</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Kidney Failure, Chronic - urine</topic><topic>Kidneys</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Practice Guidelines as Topic</topic><topic>Proportional Hazards Models</topic><topic>Proteinuria - diagnosis</topic><topic>Proteinuria - etiology</topic><topic>Proteinuria - urine</topic><topic>Renal Replacement Therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Methven, S.</creatorcontrib><creatorcontrib>Traynor, J.P.</creatorcontrib><creatorcontrib>Hair, M.D.</creatorcontrib><creatorcontrib>O'Reilly, D. St J.</creatorcontrib><creatorcontrib>Deighan, C.J.</creatorcontrib><creatorcontrib>MacGregor, M.S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>QJM : An International Journal of Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Methven, S.</au><au>Traynor, J.P.</au><au>Hair, M.D.</au><au>O'Reilly, D. St J.</au><au>Deighan, C.J.</au><au>MacGregor, M.S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria</atitle><jtitle>QJM : An International Journal of Medicine</jtitle><addtitle>QJM</addtitle><date>2011-08-01</date><risdate>2011</risdate><volume>104</volume><issue>8</issue><spage>663</spage><epage>670</epage><pages>663-670</pages><issn>1460-2725</issn><eissn>1460-2393</eissn><abstract>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 < 0.001). With multivariate analysis the risk fell below those with significant proteinuria with concordant results by ACR and TPCR but remained considerably higher than those without significant proteinuria.
Conclusions: Proteinuria screening with TPCR identifies an additional 16% of patients with significant proteinuria, not identified using ACR. This subgroup has high renal risk, and high risk of all-cause mortality and therefore warrant identification. Guideline recommendations on proteinuria screening in CKD should be reconsidered.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21382924</pmid><doi>10.1093/qjmed/hcr026</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1460-2725 |
| ispartof | QJM : An International Journal of Medicine, 2011-08, Vol.104 (8), p.663-670 |
| issn | 1460-2725 1460-2393 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_878279654 |
| source | Oxford Journals Online |
| 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 |
| title | Stratifying risk in chronic kidney disease: an observational study of UK guidelines for measuring total proteinuria and albuminuria |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-09T14%3A07%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Stratifying%20risk%20in%20chronic%20kidney%20disease:%20an%20observational%20study%20of%20UK%20guidelines%20for%20measuring%20total%20proteinuria%20and%20albuminuria&rft.jtitle=QJM%20:%20An%20International%20Journal%20of%20Medicine&rft.au=Methven,%20S.&rft.date=2011-08-01&rft.volume=104&rft.issue=8&rft.spage=663&rft.epage=670&rft.pages=663-670&rft.issn=1460-2725&rft.eissn=1460-2393&rft_id=info:doi/10.1093/qjmed/hcr026&rft_dat=%3Cproquest_cross%3E878279654%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c456t-45be446be90a696fd20d72a7179f27c73916dbde6b6e444594160ac1be582f9e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=878279654&rft_id=info:pmid/21382924&rft_oup_id=10.1093/qjmed/hcr026&rfr_iscdi=true |