Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account
<p>Introduction: Changes in urinary albumin-to-creatinine ratio (UACR) may affect the risk of advanced chronic kidney disease (CKD). How much the effect depends upon natural variation and the time period for the change is unknown.</p><p> Methods: English Clinical Practice Research...
| المؤلفون الرئيسيون: | , , , , , |
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| التنسيق: | Journal article |
| منشور في: |
Elsevier
2018
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| _version_ | 1826290686070095872 |
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| author | Smith, M Herrington, WG Weldegiorgis, M Hobbs, FDR Bankhead, C Woodward, M |
| author_facet | Smith, M Herrington, WG Weldegiorgis, M Hobbs, FDR Bankhead, C Woodward, M |
| author_sort | Smith, M |
| collection | OXFORD |
| description | <p>Introduction: Changes in urinary albumin-to-creatinine ratio (UACR) may affect the risk of advanced chronic kidney disease (CKD). How much the effect depends upon natural variation and the time period for the change is unknown.</p><p> Methods: English Clinical Practice Research Datalink records (2000-2015), with linkage to secondary care and death certification, were used to identify prospective cohorts with at least two measures of UACR within 1, 2 and 3 years. Adjusted Cox regression assessed the separate relevance of baseline UACR and UACR change to the risk of developing CKD stage 4-5 and end-stage renal disease (ESRD). Associations were compared before and after accounting for the effects of natural regression to the mean (RtM).</p><p> Results: 212,810 individuals had baseline UACR measurements; 22% had a UACR ≥3.4, and 3% had UACR ≥33.9, mg/mmol. During a median 4.0 years follow-up, 5976 developed CKD stage 4-5 and 1076 developed ESRD. There were strong associations between baseline UACR and CKD stage 4-5 or ESRD risk, which doubled in strength after accounting for RtM. Over 3 years, the hazard ratios, HRs (95%CIs) for CKD stage 4-5, relative to stable UACR, were 0.62 (0.50-0.77) for at least a halving of UACR and 2.68 (2.29-3.14) for at least a doubling. Associations were weaker for shorter exposure windows (and for cardiovascular disease or death), but strengthened after allowing for RtM.</p><p> Conclusion: Baseline values and medium term increases in albuminuria are both associated with substantially increased risk of developing advanced CKD. Standard analyses, not allowing for RtM, may underestimate these associations.</p> |
| first_indexed | 2024-03-07T02:47:59Z |
| format | Journal article |
| id | oxford-uuid:acabd926-db19-43be-bb99-a6bcd0fb48c5 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T02:47:59Z |
| publishDate | 2018 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:acabd926-db19-43be-bb99-a6bcd0fb48c52022-03-27T03:30:38ZChange in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into accountJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:acabd926-db19-43be-bb99-a6bcd0fb48c5Symplectic Elements at OxfordElsevier2018Smith, MHerrington, WGWeldegiorgis, MHobbs, FDRBankhead, CWoodward, M<p>Introduction: Changes in urinary albumin-to-creatinine ratio (UACR) may affect the risk of advanced chronic kidney disease (CKD). How much the effect depends upon natural variation and the time period for the change is unknown.</p><p> Methods: English Clinical Practice Research Datalink records (2000-2015), with linkage to secondary care and death certification, were used to identify prospective cohorts with at least two measures of UACR within 1, 2 and 3 years. Adjusted Cox regression assessed the separate relevance of baseline UACR and UACR change to the risk of developing CKD stage 4-5 and end-stage renal disease (ESRD). Associations were compared before and after accounting for the effects of natural regression to the mean (RtM).</p><p> Results: 212,810 individuals had baseline UACR measurements; 22% had a UACR ≥3.4, and 3% had UACR ≥33.9, mg/mmol. During a median 4.0 years follow-up, 5976 developed CKD stage 4-5 and 1076 developed ESRD. There were strong associations between baseline UACR and CKD stage 4-5 or ESRD risk, which doubled in strength after accounting for RtM. Over 3 years, the hazard ratios, HRs (95%CIs) for CKD stage 4-5, relative to stable UACR, were 0.62 (0.50-0.77) for at least a halving of UACR and 2.68 (2.29-3.14) for at least a doubling. Associations were weaker for shorter exposure windows (and for cardiovascular disease or death), but strengthened after allowing for RtM.</p><p> Conclusion: Baseline values and medium term increases in albuminuria are both associated with substantially increased risk of developing advanced CKD. Standard analyses, not allowing for RtM, may underestimate these associations.</p> |
| spellingShingle | Smith, M Herrington, WG Weldegiorgis, M Hobbs, FDR Bankhead, C Woodward, M Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title | Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title_full | Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title_fullStr | Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title_full_unstemmed | Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title_short | Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account |
| title_sort | change in albuminuria and risk of renal and cardiovascular outcomes natural variation should be taken into account |
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