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Comparative Study
. 2010 Aug;21(8):1355-60.
doi: 10.1681/ASN.2010010063. Epub 2010 Jul 15.

Comparison of different measures of urinary protein excretion for prediction of renal events

Hiddo J Lambers Heerspink  1 , Ron T Gansevoort, Barry M Brenner, Mark E Cooper, Hans Henrik Parving, Shahnaz Shahinfar, Dick de Zeeuw
Affiliations
Comparative Study

Comparison of different measures of urinary protein excretion for prediction of renal events

Hiddo J Lambers Heerspink et al. J Am Soc Nephrol. 2010 Aug.

Abstract

There are many methods to screen for abnormal amounts of proteinuria to identify patients at risk for progression of renal disease, but which method best predicts renal risk is unknown. Here, we analyzed a subset of 701 patients with type 2 diabetes and nephropathy participating in the Reduction of Endpoints in Non Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan (RENAAL) trial to compare the ability of urinary protein excretion (UPE) and urinary albumin excretion (UAE) from a 24-hour urine collection and urinary albumin concentration (UAC) and the albumin:creatinine ratio (ACR) from a first-morning void in predicting renal events. The primary outcome measure was the time to a doubling of serum creatinine or end-stage renal disease. During follow-up, 202 events occurred. The hazard ratios for the risk of a renal outcome (95% CIs) associated with 1-SD increment in the log-transformed measures were 3.16 (2.60 to 3.86) for UAE, 3.02 (2.53 to 3.62) for UPE, 3.23 (2.67 to 3.91) for UAC, and 4.36 (3.50 to 5.45) for ACR. The area under the ROC curve was significantly higher for ACR compared with the other measures. In conclusion, measurement of the albumin:creatinine ratio in a first-morning void is the superior method to predict renal events in patients with type 2 diabetes and nephropathy.

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Figures

Figure 1.
Figure 1.
Increased risk for renal events per standard deviation increment in baseline first morning void albumin:creatinine ratio compared to other proteinuria measures. Boxes represent the point estimate (HRs) and the horizontal bars the 95% CI. ACR, albumin:creatinine ratio; FMV, first-morning void; UAE, urinary albumin excretion; UPE, urinary protein excretion; UAC, urinary albumin concentration. Log-transformed SD: UAE = 1.1; SD UPE = 1.0; SD UAC = 1.1; SD ACR = 1.1.
Figure 2.
Figure 2.
Increased risk for renal events by quintiles of baseline first morning void albumin:creatinine ratio compared to other proteinuria measures. Boxes represent the point estimate (HRs) and the vertical bars its 95% CI. The size of the boxes are proportional to the number of events. ACR, albumin:creatinine ratio; FMV, first-morning void; UAE, urinary albumin excretion; UPE, urinary protein excretion; UAC, urinary albumin concentration.
Figure 3.
Figure 3.
Higher risk for renal events for each standard deviation decrement in baseline urinary creatinine measure. Boxes represent hazard ratios and the horizontal bars its 95% CI. SD urinary creatinine concentration FMV, 0.32; creatinine concentration 24 hours, 0.28; creatinine excretion 24 hours, 0.83. FMV, first-morning void.
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Comment in

References

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