Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

Su, Wei-Yu; Wu, Pei-Yu; Huang, Jiun-Chi; Chen, Szu-Chia; Chang, Jer-Ming

doi:10.7150/ijms.45470

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Int J Med Sci 2020; 17(8):1102-1111. doi:10.7150/ijms.45470 This issue Cite

Research Paper

Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

Wei-Yu Su^1*, Pei-Yu Wu^2,3,4*, Jiun-Chi Huang^2,3,4, Szu-Chia Chen^2,3,4,5, Jer-Ming Chang^2,4✉

1. Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;
2. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
3. Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
4. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
5. Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
^*Both are equal contributors.

✉ Corresponding author: Szu-Chia Chen, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, 482, Shan-Ming Rd., Hsiao-Kang Dist., 812 Kaohsiung, Taiwan, R.O.C. TEL: 886- 7- 8036783 - More

Citation:

Su WY, Wu PY, Huang JC, Chen SC, Chang JM. Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease. Int J Med Sci 2020; 17(8):1102-1111. doi:10.7150/ijms.45470. https://www.medsci.org/v17p1102.htm

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Abstract

Background: Patients with chronic kidney disease (CKD) are associated with high prevalence rates of proteinuria, vascular calcification and cardiomegaly. In this study, we investigated relationships among proteinuria, aortic arch calcification (AoAC) and cardio-thoracic ratio (CTR) in patients with CKD stage 3A-5. In addition, we investigated correlations among proteinuria and decline in renal function, overall and cardiovascular (CV) mortality.

Methods: We enrolled 482 pre-dialysis patients with CKD stage 3A-5, and determined AoAC and CTR using chest radiography at enrollment. The patients were stratified into four groups according to quartiles of urine protein-to-creatinine ratio (U_PCR).

Results: The patients in quartile 4 had a lower estimated glomerular filtration rate (eGFR) slope, and higher prevalence rates of rapid renal progression, progression to commencement of dialysis, overall and CV mortality. Multivariable analysis showed that a high U_PCR was associated with high AoAC (unstandardized coefficient β: 0.315; p = 0.002), high CTR (unstandardized coefficient β: 1.186; p = 0.028) and larger negative eGFR slope (unstandardized coefficient β: -2.398; p < 0.001). With regards to clinical outcomes, a high U_PCR was significantly correlated with progression to dialysis (log per 1 mg/g; hazard ratio [HR], 2.538; p = 0.003), increased overall mortality (log per 1 mg/g; HR, 2.292; p = 0.003) and increased CV mortality (log per 1 mg/g; HR, 3.195; p = 0.006).

Conclusions: Assessing proteinuria may allow for the early identification of high-risk patients and initiate interventions to prevent vascular calcification, cardiomegaly, and poor clinical outcomes.

Keywords: proteinuria, aortic arch calcification, cardio-thoracic ratio, rapid renal progression, overall mortality, cardiovascular mortality, chronic kidney disease

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APA

Su, W.Y., Wu, P.Y., Huang, J.C., Chen, S.C., Chang, J.M. (2020). Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease. International Journal of Medical Sciences, 17(8), 1102-1111. https://doi.org/10.7150/ijms.45470.

ACS

Su, W.Y.; Wu, P.Y.; Huang, J.C.; Chen, S.C.; Chang, J.M. Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease. Int. J. Med. Sci. 2020, 17 (8), 1102-1111. DOI: 10.7150/ijms.45470.

NLM

CSE

Su WY, Wu PY, Huang JC, Chen SC, Chang JM. 2020. Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease. Int J Med Sci. 17(8):1102-1111.

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