Baseline predictors of renal disease progression in the African American study of hypertension and kidney disease

• Type of Material: Article
• Authors: Keith C. Norris, Charles R. Drew University; Tom Greene, Cleveland Clinic Foundation; Joel Kopple, Harbor-UCLA Medical Center; Janice Lea, Emory University; Julia Lewis, Vanderbilt University; Mike Lipkowitz, Mount Sinai School of Medicine; Pete Miller, Johns Hopkins University; Annie Richardson, University of Southern California; Stephen Rostand, University of Alabama; Xuelei Wang, Cleveland Clinic Foundation; Lawrence J. Appel, Johns Hopkins University
• Language: English
• Date: 2006-10-01
• Publisher: American Society of Nephrology
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2006 by the American Society of Nephrology.
• Final Published Version (URL): http://dx.doi.org/10.1681/ASN.2005101101
• Title of Journal or Parent Work: Journal of the American Society of Nephrology
• Volume: 17
• Issue: 10
• Start Page: 2928
• End Page: 2936
• Grant/Funding Information: In addition to funding under a cooperative agreement from National Institute of Diabetes and Digestive and Kidney Diseases, this study was supported in part by the following institutional General Clinical Research Centers and other National Institutes of Health grants: M01 RR-00080, 5M01 RR-00071, M01 00032, P20-RR11145, M01 RR00827, M01 RR00052, 2P20 RR11104, and DK 2818-02.
• Keywords: CARDIOVASCULAR-DISEASE; ENDOTHELIAL DYSFUNCTION; DIALYSIS PATIENTS; Urology & Nephrology; RISK-FACTORS; MORTALITY; Life Sciences & Biomedicine; ALBUMIN EXCRETION; CIGARETTE-SMOKING; Science & Technology; SERUM CREATININE; UNITED-STATES; TRIAL
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Patients with chronic kidney disease have an increased risk for progression to ESRD. The purpose of this study was to examine factors that predict increased risk for adverse renal outcomes. Cox regression was performed to assess the potential of 38 baseline risk factors to predict the clinical renal composite outcome of 50% or 25-ml/min per 1.73 m2 GFR decline or ESRD among 1094 black patients with hypertensive nephrosclerosis (GFR 20 to 65 ml/min per 1.73 m2). Patients were trial participants who had been randomly assigned to one of two BP goals and to one of three antihypertensive regimens and followed for a range of 3 to 6.4 yr. In unadjusted and adjusted analyses, baseline proteinuria was consistently associated with an increased risk for adverse renal outcomes, even at low levels of proteinuria. The relationship of proteinuria with adverse renal outcomes also was evident in analyses that were stratified by level of GFR, which itself was associated with adverse renal outcomes but only at levels <40 ml/min. Other factors that were significantly associated with increased renal events after adjustment for baseline GFR, age, and gender, both with and without adjustment for baseline proteinuria, included serum creatinine, urea nitrogen, and phosphorus. In black patients with hypertensive nephrosclerosis, increased proteinuria, reduced GFR, and elevated levels of serum creatinine, urea nitrogen and phosphorus were directly associated with adverse clinical renal events. These findings identify a subset of this high-risk population that might benefit from even more aggressive treatment.