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High Levels of Proteinuria, eGFR May Increase Risk of Death, Kidney Failure CHICAGO -- February 2, 2010 -- Patients with high levels of proteinuria in addition to another marker of reduced kidney function have an associated increased risk of all-cause death, myocardial infarction (MI) or progression to kidney failure, according to a study published in the February 3 issue of JAMA. For the study, Brenda R. Hemmelgarn, MD, University of Calgary, Calgary, Alberta, and colleagues examined the association between reduced estimated rate of glomerular filtration (eGFR), proteinuria, and adverse clinical outcomes, including all-cause death, MI, and progression to kidney failure. The researchers analysed data from a province-wide (Alberta) laboratory registry that included eGFR and proteinuria measurements for 2002 to 2007. There were 920,€985 adults who had at least 1 outpatient serum creatinine measurement and who did not require renal replacement treatment at the beginning of the study. Results showed that within each level of eGFR, there was substantial variability in risk with participants who had greater amounts of proteinuria having increased adjusted rates of all 4 adverse outcomes (all-cause death, MI, end-stage renal disease, and the doubling of serum creatinine measurement [corresponding to a 50% decline in kidney function]). Patients with heavy proteinuria but without overtly abnormal eGFR appeared to have worse clinical outcomes than those with moderately reduced eGFR but without proteinuria. Significant interactions between eGFR and proteinuria were observed for death, initiation of renal replacement, and doubling of serum creatinine. “These findings are important because current guidelines for the classification and staging of chronic kidney disease (CKD) are based on eGFR without explicit consideration of the severity of concomitant proteinuria,” the authors wrote. “In addition, computerised reporting of eGFR (generally without consideration of proteinuria) is increasingly used to assist physicians in identifying patients at high risk of adverse outcomes -- or those who might benefit from specialist care.” “Although our findings do not directly address which patients would benefit from referral to a nephrologist, they do suggest that risk stratification performed in terms of eGFR alone is relatively insensitive to clinically relevant gradients in risk,” they continued. “These findings suggest that future revisions of the classification system for CKD should incorporate information from proteinuria.” SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version