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Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study
BACKGROUND: Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. METHODS: Participants were a racially and...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020240/ https://www.ncbi.nlm.nih.gov/pubmed/29940877 http://dx.doi.org/10.1186/s12882-018-0951-0 |
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author | Orlandi, Paula F. Fujii, Naohiko Roy, Jason Chen, Hsiang-Yu Lee Hamm, L. Sondheimer, James H. He, Jiang Fischer, Michael J. Rincon-Choles, Hernan Krishnan, Geetha Townsend, Raymond Shafi, Tariq Hsu, Chi-yuan Kusek, John W. Daugirdas, John T. Feldman, Harold I. |
author_facet | Orlandi, Paula F. Fujii, Naohiko Roy, Jason Chen, Hsiang-Yu Lee Hamm, L. Sondheimer, James H. He, Jiang Fischer, Michael J. Rincon-Choles, Hernan Krishnan, Geetha Townsend, Raymond Shafi, Tariq Hsu, Chi-yuan Kusek, John W. Daugirdas, John T. Feldman, Harold I. |
author_sort | Orlandi, Paula F. |
collection | PubMed |
description | BACKGROUND: Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. METHODS: Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance. RESULTS: Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1: 1.68, Year 2: 1.36), ESRD (Year 1: 1.71, Year 2: 1.39) and death (Year 1:1.92, Year 2: 1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models. CONCLUSION: In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-0951-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6020240 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-60202402018-07-06 Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study Orlandi, Paula F. Fujii, Naohiko Roy, Jason Chen, Hsiang-Yu Lee Hamm, L. Sondheimer, James H. He, Jiang Fischer, Michael J. Rincon-Choles, Hernan Krishnan, Geetha Townsend, Raymond Shafi, Tariq Hsu, Chi-yuan Kusek, John W. Daugirdas, John T. Feldman, Harold I. BMC Nephrol Research Article BACKGROUND: Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. METHODS: Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance. RESULTS: Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1: 1.68, Year 2: 1.36), ESRD (Year 1: 1.71, Year 2: 1.39) and death (Year 1:1.92, Year 2: 1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models. CONCLUSION: In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-0951-0) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-26 /pmc/articles/PMC6020240/ /pubmed/29940877 http://dx.doi.org/10.1186/s12882-018-0951-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Orlandi, Paula F. Fujii, Naohiko Roy, Jason Chen, Hsiang-Yu Lee Hamm, L. Sondheimer, James H. He, Jiang Fischer, Michael J. Rincon-Choles, Hernan Krishnan, Geetha Townsend, Raymond Shafi, Tariq Hsu, Chi-yuan Kusek, John W. Daugirdas, John T. Feldman, Harold I. Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title | Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title_full | Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title_fullStr | Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title_full_unstemmed | Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title_short | Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study |
title_sort | hematuria as a risk factor for progression of chronic kidney disease and death: findings from the chronic renal insufficiency cohort (cric) study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020240/ https://www.ncbi.nlm.nih.gov/pubmed/29940877 http://dx.doi.org/10.1186/s12882-018-0951-0 |
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