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2015 ; 373
(20
): 1916-25
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Soluble Urokinase Receptor and Chronic Kidney Disease
#MMPMID26539835
Hayek SS
; Sever S
; Ko YA
; Trachtman H
; Awad M
; Wadhwani S
; Altintas MM
; Wei C
; Hotton AL
; French AL
; Sperling LS
; Lerakis S
; Quyyumi AA
; Reiser J
N Engl J Med
2015[Nov]; 373
(20
): 1916-25
PMID26539835
show ga
BACKGROUND: Relatively high plasma levels of soluble urokinase-type plasminogen
activator receptor (suPAR) have been associated with focal segmental
glomerulosclerosis and poor clinical outcomes in patients with various
conditions. It is unknown whether elevated suPAR levels in patients with normal
kidney function are associated with future decline in the estimated glomerular
filtration rate (eGFR) and with incident chronic kidney disease. METHODS: We
measured plasma suPAR levels in 3683 persons enrolled in the Emory Cardiovascular
Biobank (mean age, 63 years; 65% men; median suPAR level, 3040 pg per milliliter)
and determined renal function at enrollment and at subsequent visits in 2292
persons. The relationship between suPAR levels and the eGFR at baseline, the
change in the eGFR over time, and the development of chronic kidney disease (eGFR
<60 ml per minute per 1.73 m(2) of body-surface area) were analyzed with the use
of linear mixed models and Cox regression after adjustment for demographic and
clinical variables. RESULTS: A higher suPAR level at baseline was associated with
a greater decline in the eGFR during follow-up; the annual change in the eGFR was
-0.9 ml per minute per 1.73 m(2) among participants in the lowest quartile of
suPAR levels as compared with -4.2 ml per minute per 1.73 m(2) among participants
in the highest quartile (P<0.001). The 921 participants with a normal eGFR (? 90
ml per minute per 1.73 m(2)) at baseline had the largest suPAR-related decline in
the eGFR. In 1335 participants with a baseline eGFR of at least 60 ml per minute
per 1.73 m(2), the risk of progression to chronic kidney disease in the highest
quartile of suPAR levels was 3.13 times as high (95% confidence interval, 2.11 to
4.65) as that in the lowest quartile. CONCLUSIONS: An elevated level of suPAR was
independently associated with incident chronic kidney disease and an accelerated
decline in the eGFR in the groups studied. (Funded by the Abraham J. and Phyllis
Katz Foundation and others.).
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