<--GAT-->

Proteinuria Lowering Can Adversely Affect Some CKD Patients

by U.S. Medicine

November 6, 2013

MEMPHIS, TN — Proteinuria-lowering interventions in patients with advanced chronic kidney disease (CKD) should be implemented cautiously, considering the potential for adverse outcomes, according to a new study led by researchers from the Memphis, TN, VAMC.

According to the report, published in the Journal of the American College of Cardiology, those patients with the lowest levels of urine microalbumin-creatinine ratio (UACR) experienced higher mortality and worse progression of CKD.1

In general, the authors write, “The risk of adverse outcomes associated with lower levels of proteinuria has been found to be linearly decreasing with even low-normal levels of microalbuminuria.” They say they embarked on their research because it was unclear “whether comorbid conditions change these associations.”

For the study, the researchers examined the association of urine microalbumin-creatinine ratio (UACR) with mortality and the slopes of estimated glomerular filtration rate (eGFR) in a nationally representative cohort of 298,875 VA patients. They focused on associations of UACR with all-cause mortality overall and in subgroups of patients with and without diabetes mellitus, hypertension, cardiovascular disease, congestive heart failure, and advanced CKD.

They found that very low levels of UACR were linearly associated with decreased mortality and less progression of CKD overall: adjusted mortality hazard ratio and estimated glomerular filtration rate slope (95% confidence interval [CI]) associated with UACR ≥200 μg/mg, compared to <5 μg/mg were 1.53 (95% CI: 1.38 to 1.69, p < 0.001) and -1.59 (95% CI: -1.83 to -1.35, p < 0.001).

“Similar linearity was present in all examined subgroups, except in patients with CKD in whom a U-shaped association was present and in whom a UACR of 10 to 19 was associated with the best outcomes,” the authors note, adding, “The association of UACR with mortality and with progressive CKD is modified in patients with CKD, who experience higher mortality and worse progression of CKD with the lowest levels of UACR.”

1. Kovesdy CP, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Molnar MZ, Kalantar-Zadeh K. Outcomes associated with microalbuminuria: effect modification by chronic kidney disease. J Am Coll Cardiol. 2013 Apr 16;61(15):1626-33. doi: 10.1016/j.jacc.2012.11.071. PubMed PMID: 23500283; PubMed Central PMCID: PMC3625505.


Related Articles

Rural Veterans With MS Benefit from Clinical Video Telehealth Rehabilitation

Of the more than 28,000 veterans with multiple sclerosis (MS) who receive care at the VHA, almost 45% of them live in rural or highly rural areas, a recent conference presentation pointed out.

Algorithm Proposed to Improve Detection of MS Lesions

Magnetic resonance imaging (MRI) is considered crucial for in vivo detection and characterization of white matter lesions (WMLs) in multiple sclerosis.


U.S. Medicine Recommends


More From department of veterans affairs

Department of Veterans Affairs (VA)

VHA Makes Progress in Improving Safety of Opioid Prescribing

VHA medical facilities should ensure that its providers are following three key opioid risk mitigation strategies, including conducting urine drug screening, a recent report recommended.

Department of Veterans Affairs (VA)

VA faces healthcare staffing shortages, barriers to hiring facility leaders

A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.

Department of Veterans Affairs (VA)

Veteran nephrologist labors to improve ESRD treatment at VA

When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.

Department of Veterans Affairs (VA)

Committee approves bill to provide agent orange benefits to ‘blue water’ vets

A long sought-after bill that would make it easier for Blue Water Navy veterans to receive Agent Orange benefits has been passed by a key House of Representatives committee.

Department of Veterans Affairs (VA)

Bill to Streamline, Expand VA’s Choice Program Signed Into Law

Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up