Elena Tynkevich1, Martin Flamant2, Jean-Philippe Haymann3, Marie Metzger1, Eric Thervet4, Jean-Jacques Boffa5, François Vrtovsnik6, Pascal Houillier7, Marc Froissart8, Bénédicte Stengel1. 1. Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France University Paris-Sud, UMRS 1018, Villejuif, France. 2. Department of Physiology, AP-HP, Hôpital Bichat, Paris, France University Paris Diderot, Paris, UMR 1149, Paris, France. 3. Department of Physiology, AP-HP, Hôpital Tenon, Paris, France Inserm UMR-S 1155, Paris, France Paris and Sorbonne University, UPMC University-Paris 6, Paris, France. 4. Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France DHU Common and Rare Arterial Diseases, AP-HP, Hôpital Européen Georges Pompidou, Paris, France. 5. Inserm UMR-S 1155, Paris, France Paris and Sorbonne University, UPMC University-Paris 6, Paris, France Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France. 6. University Paris Diderot, Paris, UMR 1149, Paris, France Department of Nephrology, AP-HP, Hôpital Bichat, Paris, France. 7. University Paris Descartes-Paris 5, UMRS 775, Paris, France Department of Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France. 8. Inserm Unit 1018, CESP, Research Centre in Epidemiology and Population Health, Villejuif, France.
Abstract
BACKGROUND: Muscle wasting predicts mortality in patients with end-stage renal disease (ESRD), but its role in the progression of chronic kidney disease (CKD) is uncertain. We studied CKD outcomes associated with low muscle mass, assessed by urinary creatinine excretion (UCr). METHODS: The NephroTest cohort included 1429 patients with CKD stages 1-4 and both measured glomerular filtration rate (mGFR) (by (51)Cr-EDTA) and estimated glomerular filtration rate (eGFR) (by CKD-Epidemiology Collaboration equation). We used cause-specific Cox models to estimate hazard ratios (HRs) for the competing risks of ESRD and death associated with gender-specific UCr quartiles. RESULTS: UCr was 13.6 ± 3.2 mmol/24 h (0.17 ± 0.05 mmol/kg/24 h) in men and 9.2 ± 2.1 (0.14 ± 0.05) in women. It was positively associated with mGFR, but not with eGFR. Over a median follow-up of 3.6 (2.1-5.8) years, 229 patients developed ESRD and 113 patients died before ESRD. Compared with patients in the highest UCr quartile, those in the lowest quartile had a higher crude HR (95% confidence interval) for pre-ESRD death: 4.3 (2.4-7.7), which was weakened, but remained statistically significant, independent of demographics, mGFR and several other factors: 2.1 (1.04-4.3). Their crude ESRD risk was not higher: HR: 0.95 (0.65-1.4), and even tended to be lower after adjusting for mGFR and log-proteinuria: HR: 0.70 (0.45-1.1). Adjustment for eGFR instead of mGFR reversed this relationship: HR: 1.7 (1.1-2.7). CONCLUSIONS: In early stage CKD, low UCr is associated with higher risk for mortality, but not for ESRD. Using creatinine-based equation to adjust for GFR may bias the relationship of UCr with ESRD risk.
BACKGROUND: Muscle wasting predicts mortality in patients with end-stage renal disease (ESRD), but its role in the progression of chronic kidney disease (CKD) is uncertain. We studied CKD outcomes associated with low muscle mass, assessed by urinary creatinine excretion (UCr). METHODS: The NephroTest cohort included 1429 patients with CKD stages 1-4 and both measured glomerular filtration rate (mGFR) (by (51)Cr-EDTA) and estimated glomerular filtration rate (eGFR) (by CKD-Epidemiology Collaboration equation). We used cause-specific Cox models to estimate hazard ratios (HRs) for the competing risks of ESRD and death associated with gender-specific UCr quartiles. RESULTS: UCr was 13.6 ± 3.2 mmol/24 h (0.17 ± 0.05 mmol/kg/24 h) in men and 9.2 ± 2.1 (0.14 ± 0.05) in women. It was positively associated with mGFR, but not with eGFR. Over a median follow-up of 3.6 (2.1-5.8) years, 229 patients developed ESRD and 113 patients died before ESRD. Compared with patients in the highest UCr quartile, those in the lowest quartile had a higher crude HR (95% confidence interval) for pre-ESRDdeath: 4.3 (2.4-7.7), which was weakened, but remained statistically significant, independent of demographics, mGFR and several other factors: 2.1 (1.04-4.3). Their crude ESRD risk was not higher: HR: 0.95 (0.65-1.4), and even tended to be lower after adjusting for mGFR and log-proteinuria: HR: 0.70 (0.45-1.1). Adjustment for eGFR instead of mGFR reversed this relationship: HR: 1.7 (1.1-2.7). CONCLUSIONS: In early stage CKD, low UCr is associated with higher risk for mortality, but not for ESRD. Using creatinine-based equation to adjust for GFR may bias the relationship of UCr with ESRD risk.
Authors: Harmke A Polinder-Bos; Hakan Nacak; Friedo W Dekker; Stephan J L Bakker; Carlo A J M Gaillard; Ron T Gansevoort Journal: Kidney Int Rep Date: 2017-03-10
Authors: Jan A J G van den Brand; Tjeerd M H Dijkstra; Jack Wetzels; Bénédicte Stengel; Marie Metzger; Peter J Blankestijn; Hiddo J Lambers Heerspink; Ron T Gansevoort Journal: PLoS One Date: 2019-05-09 Impact factor: 3.240
Authors: Charles J Blijdorp; Thomas A Hartjes; Kuang-Yu Wei; Martijn H van Heugten; Dominique M Bovée; Ricardo P J Budde; Jacqueline van de Wetering; Joost G J Hoenderop; Martin E van Royen; Robert Zietse; David Severs; Ewout J Hoorn Journal: J Extracell Vesicles Date: 2022-01