ROUTE_proteinuria

ROUTE_proteinuri

Prognosis of chronic kidney disease with normal-range proteinuria: The CKD-ROUTE study

<div><p>Background</p><p>Although lower estimated glomerular filtration rate (eGFR) and higher proteinuria are high risks for mortality and kidney outcomes, the prognosis of chronic kidney disease (CKD) in patients with normal-range proteinuria remains unclear.</p><p>Methods</p><p>In this prospective cohort study, 1138 newly visiting stage G2–G5 CKD patients were stratified into normal-range and abnormal-range proteinuria groups. Study endpoints were CKD progression (>50% eGFR loss or initiation of dialysis), cardiovascular events, and all-cause death.</p><p>Results</p><p>In total, 927 patients who were followed for >6 months were included in the analysis. The mean age was 67 years, and 70.2% were male. During a median follow-up of 35 months, CKD progression, cardiovascular events, and mortality were observed in 223, 110, and 55 patients, respectively. Patients with normal-range proteinuria had a significantly lower risk for CKD progression (hazard ratio, 0.20; 95% confidence interval, 0.10–0.38) than those with abnormal-proteinuria by multivariate Cox proportional hazard analysis. We also analyzed patients with normal-range proteinuria (n = 351). Nephrosclerosis was the most frequent cause of CKD among all patients with normal-range proteinuria (59.7%). During a median follow-up of 36 months, CKD progression, cardiovascular events, and mortality were observed in 10, 28, and 18 patients, respectively. The Kaplan–Meyer analysis demonstrated that the risks of CKD progression and cardiovascular events were not significantly different among CKD stages, whereas the risk of death was significantly higher in patients with advanced-stage CKD. Multivariate Cox proportional hazard analysis showed that the risk of three endpoints did not significantly differ among CKD stages.</p><p>Conclusion</p><p>Newly visiting CKD patients with normal-range proteinuria, who tend to be overlooked during health checkups did not exhibit a decrease in kidney function even in advanced CKD stages under specialized nephrology care.</p></div

Baseline characteristics of all the patients at enrollment (n = 927).

<p>Baseline characteristics of all the patients at enrollment (n = 927).</p

Slope of estimated glomerular filtration rate (eGFR) in patients with normal-range proteinuria from enrollment to the last visit (n = 352).

<p>Box and whisker plot (box represents the interquartile range; whiskers extend to the most extreme data point, which is no more than 1.5 times the interquartile range from the box; circles beyond the whiskers are extreme values; and the line within the box represents the median) represent changes in eGFR from baseline to the last visit.</p

Flow chart of the study design.

<p>Flow chart of the study design.</p

Loop diuretics are associated with greater risk of sarcopenia in patients with non-dialysis-dependent chronic kidney disease

<div><p>Introduction</p><p>Sarcopenia, the age-related loss of muscle mass and function, frequently accompanies chronic kidney disease. The aim of this study was to clarify the prevalence and the risk factors for sarcopenia among patients with non-dialysis-dependent chronic kidney disease (NDD-CKD), focusing on the use of drugs.</p><p>Methods</p><p>We conducted a cross-sectional analysis on a cohort of 260 patients with NDD-CKD in a university hospital, recruited between June 2016 and March 2017. We extracted data on patient gender, age, cause of chronic kidney disease, use of drugs, and comorbidities that could potentially affect the prevalence of sarcopenia. Sarcopenia was diagnosed using the criteria of the Asian Working Group for Sarcopenia. Logistic regression analysis was performed to analyze the association of each factor on the prevalence of sarcopenia.</p><p>Results</p><p>25.0% of our study subjects had sarcopenia. Multivariable analysis revealed that an increased risk of sarcopenia was significantly associated with age, male gender, body mass index, diabetes mellitus, and loop diuretic use (odds ratio, 4.59: 95% confidence interval, 1.81–11.61: <i>P</i>-value 0.001).</p><p>Conclusions</p><p>In our cohort, the prevalence of sarcopenia in patients with NDD-CKD was high, and diuretics use, particularly loop diuretic use, was suggested to be a risk factor of sarcopenia. Although loop diuretics are commonly used in patients with CKD, careful consideration of the risk of sarcopenia may be necessary.</p></div

Kaplan–Meier curves for event-free survival in patients with normal-range proteinuria according to chronic kidney disease (CKD) stage (n = 352).

<p>Kaplan–Meier analysis demonstrated that chronic kidney disease (CKD) progression (Fig 4a) and development of cardiovascular events (Fig 4b) were not significantly different among CKD stages. All-cause death was significantly higher in stage G4–G5 CKD (Fig 4c).</p

Adjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD (adjusted for loop diuretic use).

<p>Adjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD (adjusted for loop diuretic use).</p

Adjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD (adjusted for CKD stage and loop diuretic use).

<p>Adjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD (adjusted for CKD stage and loop diuretic use).</p

Unadjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD.

<p>Unadjusted odds ratios for sarcopenia in 260 elderly patients with NDD-CKD.</p