Association between urinary free light chains and progression to end stage renal disease in chronic kidney disease

被引:8
作者
Fenton, Anthony [1 ,2 ]
Jesky, Mark D. [1 ]
Webster, Rachel [3 ]
Stringer, Stephanie J. [1 ]
Yadav, Punit [1 ]
Chapple, Iain [4 ,5 ]
Dasgupta, Indranil [6 ]
Harding, Stephen J. [7 ]
Ferro, Charles J. [1 ]
Cockwell, Paul [1 ,2 ]
机构
[1] Univ Hosp Birmingham NHS Fdn Trust, Dept Renal Med, Birmingham, W Midlands, England
[2] Univ Birmingham, Inst Inflammat & Ageing, Birmingham, W Midlands, England
[3] Univ Hosp Birmingham NHS Fdn Trust, Dept Biochem, Birmingham, W Midlands, England
[4] Univ Birmingham, Inst Clin Sci, Periodontal Res Grp, Birmingham, W Midlands, England
[5] Birmingham Community Healthcare Fdn Trust, Birmingham, W Midlands, England
[6] Heart England NHS Fdn Trust, Dept Renal Med, Birmingham, W Midlands, England
[7] Binding Site, Birmingham, W Midlands, England
关键词
GLOMERULAR-FILTRATION-RATE; MOLECULAR-WEIGHT PROTEINS; COLLABORATIVE METAANALYSIS; HIGHER ALBUMINURIA; QUANTITATIVE ASSESSMENT; ALL-CAUSE; RISK; SERUM; MORTALITY; MARKER;
D O I
10.1371/journal.pone.0197043
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Patients with chronic kidney disease (CKD) are at an increased risk of developing end-stage renal disease (ESRD). We assessed for the first time whether urinary free light chains (FLC) are independently associated with risk of ESRD in patients with CKD, and whether they offer incremental value in risk stratification. Materials and methods We measured urinary FLCs in 556 patients with CKD from a prospective cohort study. The association between urinary kappa/creatinine (KCR) and lambda/creatinine (LCR) ratios and development of ESRD was assessed by competing-risks regression (to account for the competing risk of death). The change in C-statistic and integrated discrimination improvement were used to assess the incremental value of adding KCR or LCR to the Kidney Failure Risk Equation (KFRE). Results 136 participants developed ESRD during a median follow-up time of 51 months. Significant associations between KCR and LCR and risk of ESRD became non-significant after adjustment for estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR), although having a KCR or LCR >75th centile remained independently associated with risk of ESRD. Neither KCR nor LCR as continuous or categorical variables provided incremental value when added to the KFRE for estimating risk of ESRD at two years. Conclusions Urinary FLCs have an association with progression to ESRD in patients with CKD which appears to be explained to a degree by their correlation with eGFR and ACR. Levels above the 75th centile do have an independent association with ESRD, but do not improve upon a current model for risk stratification.
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