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논문분류	춘계학술대회 초록집
제목	Proteinuria Severity and Kidney Function Trajectories in Patients With Advanced Chronic Kidney Disease: Insights from CRIC and KNOW-CKD Study
저자	Cheol Ho Park
출판정보	2025; 2025(1):
키워드	Chronic kidney disease, Glomerular filtration rate, Kidney function decline, Proteinuria
초록	Proteinuria is a key determinant in staging chronic kidney disease (CKD). However, its role in predicting kidney function decline and estimating time to kidney failure in advanced CKD remains underexplored. We analyzed 2,727 participants with estimated glomerular filtration rate (eGFR) 15–45mL/min/1.73 m2 without kidney replacement therapy (KRT) from the Chronic Renal Insufficiency Cohort (CRIC) study and the KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD). The main exposures were baseline and time-updated urine protein-to-creatinine ratio (UPCR). The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of KRT. The secondary outcomes included eGFR slope (mL/min/1.73 m2/year) and time to kidney failure. During 17,069 person-years of follow-up (median 4.9 years), the primary outcome occurred in 1,474 participants (54.1%). Compared with UPCR <0.5 g/gCr, the hazard ratios (HRs) (95% CIs) for UPCR 0.5–1.0, 1.0–3.0, and ≥3.0 g/gCr were 2.08 (1.76–2.45), 3.05 (2.64–3.52), and 6.32 (5.24–7.61), respectively. This association was stronger in analysis with time-updated UPCR, with the corresponding HRs (95% CIs) of 2.58 (2.13–3.12), 5.61 (4.76–6.62), and 12.88 (10.58–15.67), respectively. In secondary analyses, the eGFR decline slopes across respective categories were -0.87 (-0.98 to -0.77), -2.32 (-2.56 to -2.07), -3.41 (-3.63 to -3.19), and -5.45 (-5.93 to -4.97) mL/min/1.73 m2 per year. Additionally, time to kidney failure (95% CIs) decreased progressively with increasing proteinuria categories, estimated at 27.7 (24.7–31.5), 9.5 (8.6–10.6), 5.9 (5.6–6.3), and 3.5 (3.2–3.9) years, respectively. Higher UPCR was strongly associated with accelerated CKD progression and a shorter time to kidney failure in advanced CKD, underscoring the critical role of proteinuria reduction in slowing kidney function decline, even in later disease stages.
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