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

I. Wen Wu, Kuang Hung Hsu, Chin Chan Lee, Chiao Yin Sun, Heng Jung Hsu, Ming Jui Hung, Mai Szu Wu

Research output: Contribution to journalArticle

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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§ssup§2§ esup§ 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§ssup§ 2§esup§ and 74.3 mL/min/1.73 m§ssup§2§esup§ 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§ssup§2§esup§ 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§ssup§ 2§esup§. The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR <45 mL/min/1.73 m§ssup§ 2§esup§. 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§ssup§2§esup§ 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.

Original languageEnglish
Article number92
JournalBMC Nephrology
Volume14
Issue number1
DOIs
Publication statusPublished - 2013

Fingerprint

Taiwan
Cohort Studies
Prospective Studies
Chronic Renal Insufficiency
Hypoalbuminemia
Kidney
Hyperphosphatemia
Hyperuricemia
Proportional Hazards Models
ROC Curve
Chronic Kidney Failure
Anemia
Dialysis
Epidemiology
Cardiovascular Diseases
Demography

Keywords

  • Anemia
  • Chronic kidney disease
  • Death
  • Hyperphosphatemia
  • Hypoalbuminemia
  • Metabolic complications
  • Renal progression

ASJC Scopus subject areas

  • Nephrology

Cite this

Re-evaluating the predictive roles of metabolic complications and clinical outcome according to eGFR levels - A four-years prospective cohort study in Taiwan. / Wu, I. Wen; Hsu, Kuang Hung; Lee, Chin Chan; Sun, Chiao Yin; Hsu, Heng Jung; Hung, Ming Jui; Wu, Mai Szu.

In: BMC Nephrology, Vol. 14, No. 1, 92, 2013.

Research output: Contribution to journalArticle

Wu, I. Wen ; Hsu, Kuang Hung ; Lee, Chin Chan ; Sun, Chiao Yin ; Hsu, Heng Jung ; Hung, Ming Jui ; Wu, Mai Szu. / Re-evaluating the predictive roles of metabolic complications and clinical outcome according to eGFR levels - A four-years prospective cohort study in Taiwan. In: BMC Nephrology. 2013 ; Vol. 14, No. 1.
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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§ssup§2§ esup§ 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§ssup§ 2§esup§ and 74.3 mL/min/1.73 m§ssup§2§esup§ 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§ssup§2§esup§ 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§ssup§ 2§esup§. The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR <45 mL/min/1.73 m§ssup§ 2§esup§. 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§ssup§2§esup§ 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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AU - Wu, I. Wen

AU - Hsu, Kuang Hung

AU - Lee, Chin Chan

AU - Sun, Chiao Yin

AU - Hsu, Heng Jung

AU - Hung, Ming Jui

AU - Wu, Mai Szu

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N2 - 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§ssup§2§ esup§ 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§ssup§ 2§esup§ and 74.3 mL/min/1.73 m§ssup§2§esup§ 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§ssup§2§esup§ 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§ssup§ 2§esup§. The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR <45 mL/min/1.73 m§ssup§ 2§esup§. 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§ssup§2§esup§ 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.

AB - 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§ssup§2§ esup§ 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§ssup§ 2§esup§ and 74.3 mL/min/1.73 m§ssup§2§esup§ 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§ssup§2§esup§ 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§ssup§ 2§esup§. The number of complications (≥ 3) independently predicted both endpoints in patients with eGFR <45 mL/min/1.73 m§ssup§ 2§esup§. 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§ssup§2§esup§ 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.

KW - Anemia

KW - Chronic kidney disease

KW - Death

KW - Hyperphosphatemia

KW - Hypoalbuminemia

KW - Metabolic complications

KW - Renal progression

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