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The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension.

Publication ,  Journal Article
Lea, J; Greene, T; Hebert, L; Lipkowitz, M; Massry, S; Middleton, J; Rostand, SG; Miller, E; Smith, W; Bakris, GL
Published in: Arch Intern Med
April 25, 2005

BACKGROUND: The magnitude of proteinuria is associated with a graded increase in the risk of progression to end-stage renal disease and cardiovascular events. The objective of this study was to relate baseline and early changes in proteinuria and glomerular filtration rate (GFR) to long-term progression of hypertensive nondiabetic kidney disease. METHODS: Post hoc analysis of a randomized 3 x 2 factorial trial. A total of 1094 African Americans with hypertensive renal disease (GFR, 20-65 mL/min per 1.73 m(2)) were followed up for a median of 3.8 years. Participants were randomized to a mean arterial pressure goal of 102 to 107 mm Hg (usual) or 92 mm Hg or less (lower) and to initial treatment with a beta-blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ramipril), or a dihydropyridine calcium channel blocker (amlodipine) RESULTS: Baseline proteinuria and GFR predicted the rgate of GFR decline. For each 10-mL/min per 1.73 m(2) lower baseline GFR, an associated mean +/- SE 0.38 +/- 0.08-mL/min per 1.73 m(2) per year greater mean GFR decline occurred, and for each 2-fold higher proteinuria level, a mean +/- SE 0.54 +/- 0.05-mL/min per 1.73 m(2) per year faster GFR decline was observed (P < .001 for both). In multivariate analysis, the effect of baseline proteinuria GFR decline persisted. Initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d. CONCLUSIONS: The change in the level of proteinuria is a predictor of subsequent progression of hypertensive kidney disease at a given GFR. A prospective trial is needed to confirm this observation.

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Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

April 25, 2005

Volume

165

Issue

8

Start / End Page

947 / 953

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Ramipril
  • Proteinuria
  • Prognosis
  • Middle Aged
  • Metoprolol
  • Male
  • Kidney Failure, Chronic
 

Citation

APA
Chicago
ICMJE
MLA
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Lea, J., Greene, T., Hebert, L., Lipkowitz, M., Massry, S., Middleton, J., … Bakris, G. L. (2005). The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Arch Intern Med, 165(8), 947–953. https://doi.org/10.1001/archinte.165.8.947
Lea, Janice, Tom Greene, Lee Hebert, Michael Lipkowitz, Shaul Massry, John Middleton, Stephen G. Rostand, Edgar Miller, Winifred Smith, and George L. Bakris. “The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension.Arch Intern Med 165, no. 8 (April 25, 2005): 947–53. https://doi.org/10.1001/archinte.165.8.947.
Lea J, Greene T, Hebert L, Lipkowitz M, Massry S, Middleton J, et al. The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Arch Intern Med. 2005 Apr 25;165(8):947–53.
Lea, Janice, et al. “The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension.Arch Intern Med, vol. 165, no. 8, Apr. 2005, pp. 947–53. Pubmed, doi:10.1001/archinte.165.8.947.
Lea J, Greene T, Hebert L, Lipkowitz M, Massry S, Middleton J, Rostand SG, Miller E, Smith W, Bakris GL. The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Arch Intern Med. 2005 Apr 25;165(8):947–953.

Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

April 25, 2005

Volume

165

Issue

8

Start / End Page

947 / 953

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Ramipril
  • Proteinuria
  • Prognosis
  • Middle Aged
  • Metoprolol
  • Male
  • Kidney Failure, Chronic