The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease: Results of the African American Study of Kidney Disease and Hypertension.
Lea, Janice MD; Greene, Tom PhD; Hebert, Lee MD; Lipkowitz, Michael MD; Massry, Shaul MD; Middleton, John MD; Rostand, Stephen G. MD; Miller, Edgar MD, PhD; Smith, Winifred MPH; Bakris, George L. MD; for the African American Study of Kidney Disease and Hypertension Study Group
[Article]
Archives of Internal Medicine.
165(8):947-953, April 25, 2005.
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Background: The magnitude of proteinuria is associated with a graded increase in the risk of progression to end-stage renal disease and cardiovascular events. The objective of this study was to relate baseline and early changes in proteinuria and glomerular filtration rate (GFR) to long-term progression of hypertensive nondiabetic kidney disease.
Methods: Post hoc analysis of a randomized 3 x 2 factorial trial. A total of 1094 African Americans with hypertensive renal disease (GFR, 20-65 mL/min per 1.73 m2) were followed up for a median of 3.8 years. Participants were randomized to a mean arterial pressure goal of 102 to 107 mm Hg (usual) or 92 mm Hg or less (lower) and to initial treatment with a [beta]-blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ramipril), or a dihydropyridine calcium channel blocker (amlodipine)
Results: Baseline proteinuria and GFR predicted the rgate of GFR decline. For each 10-mL/min per 1.73 m2 lower baseline GFR, an associated mean /- SE 0.38 /- 0.08-mL/min per 1.73 m2 per year greater mean GFR decline occurred, and for each 2-fold higher proteinuria level, a mean /- SE 0.54 /- 0.05-mL/min per 1.73 m2 per year faster GFR decline was observed (P < .001 for both). In multivariate analysis, the effect of baseline proteinuria GFR decline persisted. Initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d.
Conclusions: The change in the level of proteinuria is a predictor of subsequent progression of hypertensive kidney disease at a given GFR. A prospective trial is needed to confirm this observation.
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