Reappraisal of Proteinuria and Estimated GFR to Predict Progression to ESRD or Death for Hospitalized Chronic Kidney Disease Patients

Abstract

Background: Despite the high prevalence of chronic kidney disease (CKD) in the general population, few CKD patients progress to end-stage renal disease (ESRD). Adding the criterion of proteinuria to the CKD classification could improve screening and therapeutic strategies. Method: We analyzed data from 5122 inpatients who were admitted to our hospital from 2002 to 2003 to survey prevalence of kidney insufficiency, renal survival, mortality, and blood pressure during hospitalization. Results: Among 999 (19.5%) patients with proteinuria of 2+ or more or eGFR under 60 (mL/min/1.73 m²), 56 (9.0%; 95% CI, 6.7–11.4) patients progressed to ESRD (false positive (FP) rate: 18.6%; likelihood ratio (LR): 5.28) and 246 (28.4%; 95% CI, 25.3–31.5) patients died at 5 years. Restricting the focus to patients with proteinuria of 2+ or more or eGFR under 30 reduced the optimal participants by 12.0%, identified 48 (12.4%; 95% CI, 9.0–15.8) patients progressing to ESRD with rising predictive power (FP rate: 11.2%; LR: 7.52) and 162 (29.6%; 95% CI, 25.6–33.5) patients died. The predictors for ESRD were the baseline kidney dysfunction with higher levels of proteinuria, hypertension, and older age. The predictors for death were proteinuria, hypotension, older age, and male. The risk for ESRD differed by levels of proteinuria even though eGFR were in the same levels. In the older CKD inpatients with fewer levels of proteinuria, mortality was raised rather than the rate of the progression to ESRD. Conclusions: Reappraisal by combining proteinuria and eGFR improves prediction of ESRD or death.

• proteinuria
• eGFR
• end-stage renal disease
• mortality
• predictor

Acknowledgements

We wish to express our deep appreciation to Ryoichi Asayama in the Division of Electronic Calculation and Toshihiko Ota in the Division of medical record administration, Purser Department in our center, for cooperation to extract electronic information.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.