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Deprecated: Implicit conversion from float 296.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Am+J+Kidney+Dis 2016 ; 68 (1): 68-76 Nephropedia Template TP
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Serum ?-Trace Protein and ?2-Microglobulin as Predictors of ESRD, Mortality, and Cardiovascular Disease in Adults With CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study #MMPMID26948990
Foster MC; Coresh J; Hsu Cy; Xie D; Levey AS; Nelson RG; Eckfeldt JH; Vasan RS; Kimmel PL; Schelling J; Simonson M; Sondheimer JH; Anderson AH; Akkina S; Feldman HI; Kusek JW; Ojo AO; Inker LA
Am J Kidney Dis 2016[Jul]; 68 (1): 68-76 PMID26948990show ga
Background: Serum ?-trace protein (BTP) and ?2-microglobulin (B2M) are independently associated with end-stage renal disease (ESRD) and mortality in the general population and high-risk groups with diabetes or advanced chronic kidney disease (CKD). Less is known about their associations with outcomes and predictive ability in adults with moderate CKD. Study Design: Prospective cohort study. Setting & Participants: 3613 adults from the Chronic Renal Insufficiency Cohort (CRIC) Study (45% women; mean age, 57.9 years; 41.0% non-Hispanic black; 51.9% with diabetes). Predictors: BTP and B2M with a reciprocal transformation to reflect their associations with filtration, creatinine-based estimated glomerular filtration rate (eGFRcr), measured GFR (mGFR) and a 4-marker composite score combining BTP, B2M, creatinine, and cystatin C. Predictors were standardized as z scores for comparisons across filtration markers. Outcomes: ESRD, all-cause mortality, and new-onset cardiovascular disease. Results: Over a six-year median follow-up, 755 (21%) participants developed ESRD, 653 died, and 292 developed new-onset cardiovascular disease. BTP, B2M, and the 4-marker composite were independent predictors of ESRD and all-cause mortality, and B2M and the 4-marker composite of cardiovascular events, after multivariable adjustment. These associations were stronger than those observed for eGFRcr (p vs. eGFRcr ?0.02). The 4-marker composite led to improvements in the C statistic and 2.5 year risk reclassification beyond eGFRcr for all outcomes. Limitations: Filtration markers measured at one time point; mGFR available in subset of cohort. Conclusions: BTP and B2M may contribute additional risk information beyond eGFRcr and the use of multiple-markers may improve risk prediction beyond this well-established marker of kidney function among persons with moderate CKD.