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Re-evaluating the predictive roles of metabolic complications and clinical outcome according to eGFR levels--a four-years prospective cohort study in Taiwan.

Wu IW, Hsu KH, Lee CC, Sun CY, Hsu HJ, Hung MJ, Wu MS - BMC Nephrol (2013)

Bottom Line: Metabolic complications are associated with clinical outcomes in patients with chronic kidney disease (CKD).Those CKD-related complications associated with death were hypoalbuminemia and hyperuricemia.The findings from the present study offer a novel insight into the association between metabolic complications and patient outcomes and may help to refine risk stratification according to disease stage.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.

ABSTRACT

Background: Metabolic complications are associated with clinical outcomes in patients with chronic kidney disease (CKD). These outcomes differ among patients according to the different stages of disease. The prevalence and association of type and number of metabolic complications with renal progression and death in patients having different eGFR levels has high clinical value, but this fact has been rarely evaluated in prospective studies.

Methods: We prospectively followed a cohort of 1157 CKD patients from 2006 to death or until 2010, and evaluated the prevalence of CKD-related complications and their association with renal progression (defined as a decline in eGFR by > 50% from baseline, or end-stage renal disease requiring dialysis) and death in patients with eGFRs above and below 45 mL/min/1.73 m(2) using Cox-proportional hazard models.

Results: The estimated rate (per 100 patient-years) of renal progression and death were 11.9 and 4.9, respectively. The eGFR thresholds determined by ROC analysis with a sensitivity of 90% for any metabolic complication were 60.8 mL/min/1.73 m(2) and 74.3 mL/min/1.73 m(2) using the MDRD and CKD Epidemiology Collaboration equations, respectively. CKD-related complications associated with renal progression in patients having eGFR < 45 mL/min/1.73 m(2) were hyperphosphatemia, anemia, microinflammation and hypoalbuminemia. Those CKD-related complications associated with death were hypoalbuminemia and hyperuricemia. Hypoalbuminemia predicted renal progression, and, hypoalbuminemia and microinflammation predicted death in patients with eGFR ≥ 45 mL/min/1.73 m(2). The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR < 45 mL/min/1.73 m(2).

Conclusions: Hypoalbuminemia was a unique and strong predictor of renal progression and all-cause mortality in CKD patients, independent of their demographic characteristics, traditional risk factors, renal function severity, the presence of cardiovascular disease and other metabolic abnormalities. Most other metabolic complications and the number of complications (≥ 3) were associated with the clinical outcomes of patients with eGFR < 45 mL/min/1.73 m(2) rather than in those with higher eGFRs. The findings from the present study offer a novel insight into the association between metabolic complications and patient outcomes and may help to refine risk stratification according to disease stage.

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Cumulative renal (A) and overall survival (B) based on hypoalbuminemia and presence of more than 3 metabolic complications in patients with eGFR below 45 mL/min per 1.73 m2 (log-rank test, p < 0.001).
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Figure 3: Cumulative renal (A) and overall survival (B) based on hypoalbuminemia and presence of more than 3 metabolic complications in patients with eGFR below 45 mL/min per 1.73 m2 (log-rank test, p < 0.001).

Mentions: The presence of ≥3 metabolic complications (HR: 3.71; 95% CI: 2.35–5.87; p < 0.001, model 1), hyperuricemia (HR: 2.09; 95% CI: 1.39–3.13; p < 0.001) and hypoalbuminemia (HR: 2.39; 95% CI: 1.54–3.69; p < 0.001, model 2) independently predicted death in patients with eGFR < 45 mL/min/1.73 m2 (Table 5). Hypoalbuminemia (HR: 5.87; 95% CI: 1.22–8.21; p = 0.001) and microinflammation (HR: 3.31; 95% CI: 1.61–7.82; p = 0.027) independently predicted death in patients with higher eGFR (Table 5). The presence of ≥3 metabolic complications and hypoalbuminemia had the greatest contribution to the prediction of both renal progression and death in patients with eGFR < 45mL/min/1.73 m2, as determined by percent reduction of pseudo- R2 values. Figure 2 shows the cumulative renal survival and overall survival according to eGFRs and the presence of hypoalbuminemia. Cumulative renal survival and overall survival, according to the number of complications and hypoalbuminemia in patients with eGFR < 45 mL/min/1.73 m2 are illustrated in Figure 3.


Re-evaluating the predictive roles of metabolic complications and clinical outcome according to eGFR levels--a four-years prospective cohort study in Taiwan.

Wu IW, Hsu KH, Lee CC, Sun CY, Hsu HJ, Hung MJ, Wu MS - BMC Nephrol (2013)

Cumulative renal (A) and overall survival (B) based on hypoalbuminemia and presence of more than 3 metabolic complications in patients with eGFR below 45 mL/min per 1.73 m2 (log-rank test, p < 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643890&req=5

Figure 3: Cumulative renal (A) and overall survival (B) based on hypoalbuminemia and presence of more than 3 metabolic complications in patients with eGFR below 45 mL/min per 1.73 m2 (log-rank test, p < 0.001).
Mentions: The presence of ≥3 metabolic complications (HR: 3.71; 95% CI: 2.35–5.87; p < 0.001, model 1), hyperuricemia (HR: 2.09; 95% CI: 1.39–3.13; p < 0.001) and hypoalbuminemia (HR: 2.39; 95% CI: 1.54–3.69; p < 0.001, model 2) independently predicted death in patients with eGFR < 45 mL/min/1.73 m2 (Table 5). Hypoalbuminemia (HR: 5.87; 95% CI: 1.22–8.21; p = 0.001) and microinflammation (HR: 3.31; 95% CI: 1.61–7.82; p = 0.027) independently predicted death in patients with higher eGFR (Table 5). The presence of ≥3 metabolic complications and hypoalbuminemia had the greatest contribution to the prediction of both renal progression and death in patients with eGFR < 45mL/min/1.73 m2, as determined by percent reduction of pseudo- R2 values. Figure 2 shows the cumulative renal survival and overall survival according to eGFRs and the presence of hypoalbuminemia. Cumulative renal survival and overall survival, according to the number of complications and hypoalbuminemia in patients with eGFR < 45 mL/min/1.73 m2 are illustrated in Figure 3.

Bottom Line: Metabolic complications are associated with clinical outcomes in patients with chronic kidney disease (CKD).Those CKD-related complications associated with death were hypoalbuminemia and hyperuricemia.The findings from the present study offer a novel insight into the association between metabolic complications and patient outcomes and may help to refine risk stratification according to disease stage.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.

ABSTRACT

Background: Metabolic complications are associated with clinical outcomes in patients with chronic kidney disease (CKD). These outcomes differ among patients according to the different stages of disease. The prevalence and association of type and number of metabolic complications with renal progression and death in patients having different eGFR levels has high clinical value, but this fact has been rarely evaluated in prospective studies.

Methods: We prospectively followed a cohort of 1157 CKD patients from 2006 to death or until 2010, and evaluated the prevalence of CKD-related complications and their association with renal progression (defined as a decline in eGFR by > 50% from baseline, or end-stage renal disease requiring dialysis) and death in patients with eGFRs above and below 45 mL/min/1.73 m(2) using Cox-proportional hazard models.

Results: The estimated rate (per 100 patient-years) of renal progression and death were 11.9 and 4.9, respectively. The eGFR thresholds determined by ROC analysis with a sensitivity of 90% for any metabolic complication were 60.8 mL/min/1.73 m(2) and 74.3 mL/min/1.73 m(2) using the MDRD and CKD Epidemiology Collaboration equations, respectively. CKD-related complications associated with renal progression in patients having eGFR < 45 mL/min/1.73 m(2) were hyperphosphatemia, anemia, microinflammation and hypoalbuminemia. Those CKD-related complications associated with death were hypoalbuminemia and hyperuricemia. Hypoalbuminemia predicted renal progression, and, hypoalbuminemia and microinflammation predicted death in patients with eGFR ≥ 45 mL/min/1.73 m(2). The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR < 45 mL/min/1.73 m(2).

Conclusions: Hypoalbuminemia was a unique and strong predictor of renal progression and all-cause mortality in CKD patients, independent of their demographic characteristics, traditional risk factors, renal function severity, the presence of cardiovascular disease and other metabolic abnormalities. Most other metabolic complications and the number of complications (≥ 3) were associated with the clinical outcomes of patients with eGFR < 45 mL/min/1.73 m(2) rather than in those with higher eGFRs. The findings from the present study offer a novel insight into the association between metabolic complications and patient outcomes and may help to refine risk stratification according to disease stage.

Show MeSH
Related in: MedlinePlus