Cross Sectional Analysis of Complications of Chronic Kidney Disease by Glomerular Filtration Rate and Albuminuria.
Introduction: Albuminuria is strongly associated with future risk for cardiovascular and
kidney outcomes, and has been proposed to be included in the classification of chronic
kidney disease (CKD) along with glomerular filtration rate (GFR). However, it is not
known whether albuminuria is associated with concurrent complications of CKD. We aimed
to determine the association of album... read moreinuria with the complications of CKD in
participants screened for enrollment in the Modification of Diet in Renal Disease (MDRD)
Study. Methods: In a cross-sectional analysis of 1665 participants screened for the MDRD
Study, the association of albumin-creatinine ratio (ACR) and GFR with anemia (hemoglobin
< 12 g/dL for women, <13.5 g/dL for men), acidosis (bicarbonate < 22 mmol/L),
hyperphosphatemia (phosphate > 4.6 mg/dL) and hypertension (based on review of
medical records and anti-hypertensive medication use) was evaluated using logistic and
log-binomial regression. Albuminuria was determined by converting proteinuria to ACR and
GFR was measured using iothalamate clearance. Results: Mean GFR (±SD) was 39
ml/min/1.73m2 (± 21) and the median (inter-quartile range, IQR) ACR was 152 (631)
mg/g). In multivariable models adjusted for age, sex, race, kidney disease etiology and
GFR, higher levels of ACR levels (>300 mg/g) were not associated with any
complication (odds ratio (95% CI) for anemia 0.96 (0.66-1.39), acidosis 1.18
(0.80-1.74), hyperphosphatemia 1.83 (0.83-4.02) and hypertension 1.40 (0.91-2.16)) when
compared to ACR levels <29 mg/g. Lower levels of GFR, however were associated with
all complications (p-values < 0.0001 for all complications). GFR levels lower than 29
ml/min/1.73m2 were associated with higher odds (95% CI) of anemia 12.8 (8.4-19.3),
acidosis 8.9 (5.4-14.8), hyperphosphatemia 36.2 (11.4-114.9) and hypertension 2.7
(1.8-3.9) compared to GFR levels 60-89 ml/min/1.73m2. Conclusions: ACR alone does not
appear to provide additional information regarding CKD complications. Albuminuria may be
included along with GFR in the classification of CKD based on the prognostic outcomes,
but would not affect clinical action plans for decisions regarding evaluation and
treatment of complications.
Thesis (M.S.)--Tufts University, 2011.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Mark Sarnak, and Lesley Stevens.
Committee: Hocine Tighiouart.
Keyword: Medicine.read less