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. 2017 Jan;91(1):196-203.
doi: 10.1016/j.kint.2016.09.003. Epub 2016 Oct 28.

Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression

Chi-Yuan Hsu  1 , Dawei Xie  2 , Sushrut S Waikar  3 , Joseph V Bonventre  3 , Xiaoming Zhang  2 , Venkata Sabbisetti  3 , Theodore E Mifflin  2 , Josef Coresh  4 , Clarissa J Diamantidis  5 , Jiang He  6 , Claudia M Lora  7 , Edgar R Miller  4 , Robert G Nelson  8 , Akinlolu O Ojo  9 , Mahboob Rahman  10 , Jeffrey R Schelling  10 , Francis P Wilson  11 , Paul L Kimmel  12 , Harold I Feldman  2 , Ramachandran S Vasan  13 , Kathleen D Liu  14 ; CRIC Study Investigators; CKD Biomarkers Consortium
Collaborators, Affiliations

Urine biomarkers of tubular injury do not improve on the clinical model predicting chronic kidney disease progression

Chi-Yuan Hsu et al. Kidney Int. 2017 Jan.

Abstract

Few investigations have evaluated the incremental usefulness of tubular injury biomarkers for improved prediction of chronic kidney disease (CKD) progression. As such, we measured urinary kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, N-acetyl-ß-D-glucosaminidase and liver fatty acid binding protein under highly standardized conditions among 2466 enrollees of the prospective Chronic Renal Insufficiency Cohort Study. During 9433 person-years of follow-up, there were 581 cases of CKD progression defined as incident end-stage renal disease or halving of the estimated glomerular filtration rate. Levels of the urine injury biomarkers, normalized for urine creatinine, were strongly associated with CKD progression in unadjusted Cox proportional hazard models with hazard ratios in the range of 7 to 15 comparing the highest with the lowest quintiles. However, after controlling for the serum creatinine-based estimated glomerular filtration rate and urinary albumin/creatinine ratio, none of the normalized biomarkers was independently associated with CKD progression. None of the biomarkers improved on the high (0.89) C-statistic for the base clinical model. Thus, among patients with CKD, risk prediction with a clinical model that includes the serum creatinine-based estimated glomerular filtration rate and the urinary albumin/creatinine ratio is not improved on with the addition of renal tubular injury biomarkers.

Keywords: chronic kidney disease; microalbuminuria; proteinuria.

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Figures

Figure 1a–1d
Figure 1a–1d
Kaplan-Meier survival curves for CKD progression by biomarker quintile (all log-rank p-values < 0.0001) (Q1 is lowest quartile and Q5 is highest quartile)
Figure 1a–1d
Figure 1a–1d
Kaplan-Meier survival curves for CKD progression by biomarker quintile (all log-rank p-values < 0.0001) (Q1 is lowest quartile and Q5 is highest quartile)
Figure 1a–1d
Figure 1a–1d
Kaplan-Meier survival curves for CKD progression by biomarker quintile (all log-rank p-values < 0.0001) (Q1 is lowest quartile and Q5 is highest quartile)
Figure 1a–1d
Figure 1a–1d
Kaplan-Meier survival curves for CKD progression by biomarker quintile (all log-rank p-values < 0.0001) (Q1 is lowest quartile and Q5 is highest quartile)
See this image and copyright information in PMC

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References

    1. Fassett RG, Venuthurupalli SK, Gobe GC, et al. Biomarkers in chronic kidney disease: a review. Kidney Int. 2011;80:806–821. - PubMed
    1. Brosius FC, Pennathur S. How to find a prognostic biomarker for progressive diabetic nephropathy. Kidney Int. 2013;83:996–998. - PMC - PubMed
    1. Merchant ML. Can the urinary peptidome outperform creatinine and albumin to predict renal function decline? J Am Soc Nephrol. 2015;26:1760–1761. - PMC - PubMed
    1. Peralta CA, Katz R, Bonventre JV, et al. Associations of urinary levels of kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) with kidney function decline in the Multi-Ethnic Study of Atherosclerosis (MESA) Am J Kidney Dis. 2012;60:904–911. - PMC - PubMed
    1. Liu KD, Yang W, Anderson AH, et al. Urine neutrophil gelatinase-associated lipocalin levels do not improve risk prediction of progressive chronic kidney disease. Kidney Int. 2013;83:909–914. - PMC - PubMed

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