In a large cohort study, relative mortality risk for reduced eGFR was higher in every age category, but fell with increasing age (P<0.05), with similar albeit less evident findings for increased albuminuria, Josef Coresh, MD, PhD, of the Chronic Kidney Disease Prognosis Consortium Data Coordinating Center in Baltimore, and colleagues reported online in the Journal of the American Medical Association.
Overall, Coresh and colleagues found that death and ESRD risks were higher at lower eGFR and higher albuminuria in every age category.
eGFR
Proteinuria Matters
The risks of mortality, myocardial infarction, and progression to kidney failure associated with a given level of eGFR are independently increased in patients with higher levels of proteinuria.
How to Predict the Probability of ESRD
Among the predictive models, the best clinical model based on age, gender, physical activity, diabetes, systolic blood pressure, antihypertensive medication, and HDL cholesterol correctly classified 86.4% of patients in the general population who did and did not progress to end-stage renal disease.
The albumin-to-creatinine ratio performed better, correctly identifying 89.3%. Estimated GFR alone was better yet (93.3%).
Combining the two marginally improved prediction overall (93.6%), but substantially improved the more important true-positive rate across all potential screening populations.
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