Journal
BMC NEPHROLOGY
Volume 19, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12882-018-0951-0
Keywords
Hematuria; Epidemiology; CKD; Risk factors; CKD progression; ESRD; Mortality
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award [NIH/NCATS UL1TR000003]
- Johns Hopkins University [UL1TR000424]
- University of Maryland [GCRC M01RR-16500]
- National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health [UL1TR000439]
- Michigan Institute for Clinical and Health Research (MICHR) [UL1TR000433]
- University of Illinois at Chicago [CTSA UL1RR029879]
- Tulane COBRE for Clinical and Translational Research in Cardio-metabolic Diseases [P20 GM109036]
- Kaiser Permanente NIH/NCRR UCSF-CTSI [UL1 RR-024131]
- Clinical and Translational Science Collaborative of Cleveland
- NIH roadmap for Medical Research
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Background: Hematuria is associated with chronic kidney disease (CKD), but has rarely been examined as a risk factor for CKD progression. We explored whether individuals with hematuria had worse outcomes compared to those without hematuria in the CRIC Study. Methods: Participants were a racially and ethnically diverse group of adults (21 to 74 years), with moderate CKD. Presence of hematuria (positive dipstick) from a single urine sample was the primary predictor. Outcomes included a 50% or greater reduction in eGFR from baseline, ESRD, and death, over a median follow-up of 7.3 years, analyzed using Cox Proportional Hazards models. Net reclassification indices (NRI) and C statistics were calculated to evaluate their predictive performance. Results: Hematuria was observed in 1145 (29%) of a total of 3272 participants at baseline. Individuals with hematuria were more likely to be Hispanic (22% vs. 9.5%, respectively), have diabetes (56% vs. 48%), lower mean eGFR (40.2 vs. 45.3 ml/min/1.73 m2), and higher levels of urinary albumin > 1.0 g/day (36% vs. 10%). In multivariable-adjusted analysis, individuals with hematuria had a greater risk for all outcomes during the first 2 years of follow-up: Halving of eGFR or ESRD (HR Year 1:1.68, Year 2:1.36), ESRD (Year 1:1.71, Year 2:1.39) and death (Year 1:1.92, Year 2:1.77), and these associations were attenuated, thereafter. Based on NRIs and C-statistics, no clear improvement in the ability to improve prediction of study outcomes was observed when hematuria was included in multivariable models. Conclusion: In a large adult cohort with CKD, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up but did not improve risk prediction.
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