Elsevier

Kidney International

Volume 60, Issue 3, September 2001, Pages 1131-1140
Kidney International

Clinical Nephrology – Epidemiology – Clinical Trials
Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease

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Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease.

Background

Angiotensin-converting enzyme (ACE) inhibitors reduce urine protein excretion and slow the progression of renal disease. The beneficial effect in slowing the progression of renal disease is greater in patients with higher urine protein excretion at the onset of treatment. We hypothesized that the greater beneficial effect of ACE inhibitors on the progression of renal disease in patients with higher baseline levels of proteinuria is due to their greater antiproteinuric effect in these patients.

Methods

Data were analyzed from 1860 patients enrolled in 11 randomized controlled trials comparing the effect of antihypertensive regimens, including ACE inhibitors to regimens not including ACE inhibitors on the progression of non-diabetic renal disease. Multivariable linear regression analysis was used to assess the relationship between the level of proteinuria at baseline and changes in urine protein excretion during follow-up. The Cox proportional hazards analysis was used to assess the relationship between changes in urine protein excretion during follow-up and the effect of ACE inhibitors on the time to doubling of baseline serum creatinine values or onset of end-stage renal disease.

Results

Mean (median) baseline urine protein excretion was 1.8 (0.94) g/day. Patients with higher baseline urine protein excretion values had a greater reduction in proteinuria during the follow-up in association with treatment with ACE inhibitors and in association with lowering systolic and diastolic blood pressures (interaction P < 0.001 for all). A higher level of urine protein excretion during follow-up (baseline minus change) was associated with a greater risk of progression [relative risk 5.56 (3.87 to 7.98) for each 1.0 g/day higher protein excretion]. After controlling for the current level of urine protein excretion, the beneficial effect of ACE inhibitors remained significant [relative risk for ACE inhibitors vs. control was 0.66 (0.52 to 0.83)], but there was no significant interaction between the beneficial effect of ACE inhibitors and the baseline level of urine protein excretion.

Conclusions

The antiproteinuric effects of ACE inhibitors and lowering blood pressure are greater in patients with a higher baseline urine protein excretion. The greater beneficial effect of ACE inhibitors on renal disease progression in patients with higher baseline proteinuria can be explained by their greater antiproteinuric effects in these patients. The current level of urine protein excretion is a modifiable risk factor for the progression of non-diabetic renal disease. ACE inhibitors provide greater beneficial effect at all levels of current urine protein excretion.

Keywords

ACE inhibitors
antihypertensive therapy
urine protein
blood pressure
management of renal disease
angiotensin-converting enzyme
kidney failure

Cited by (0)

1

Other members of the Angiotensin-Converting Enzyme Inhibition and Progression of Renal Disease (AIPRD) Study Group include: R. Toto (Dallas, TX, USA), B.M. Brenner (Boston, MA, USA), A. Kamper (Copenhagen, Denmark), P. Zucchelli (Malpighi-Bologna, Italy), G. Becker (Melbourne, Australia), A. Himmelmann (Goteborg, Sweden), K. Bannister (Adelaide, Australia), P. Landais (Paris, France), A. Perna (Bergamo, Italy), S. Strandgaard (Copenhagen, Denmark), B.U. Ihle (Melbourne, Australia), L. Hannson (Goteborg, Sweden), J.P. Grünfeld (Paris, France), G.G. Van Essen (Groningen, The Netherlands), A.J. Apperloo (Groningen, The Netherlands), L. Oldrizzi (Verona, Italy), N.E. Madias (Boston, MA, USA), B. Delano (Brooklyn, NY, USA), T. Karim (Boston, MA, USA), and M. Reddy (Boston, MA, USA).