Estimated Kidney Tubular Secretion and Kidney, Cardiovascular, and Mortality Outcomes in CKD: The Systolic Blood Pressure Intervention Trial
Year: 2022
Type: article
Abstract: Rational & Objective: Many drugs, metabolites, and toxins are cleared by the kidneys via tubular secretion. Whether novel endogenous measures of tubular secretion provide information about kidney, cardiovascular, and mortality risk is uncertain. Study Design: Longitudinal subgroup analysis of clinical trial participants. Setting & Participants: at baseline. Exposure: Summary score incorporating urine-to-plasma ratios of 10 endogenous secretion markers measured in paired urine and plasma samples at baseline. Outcome: The primary outcome was longitudinal change in eGFR. Secondary outcomes included chronic kidney disease (CKD) progression (≥50% eGFR decline or incident kidney failure requiring dialysis or kidney transplantation), a cardiovascular disease (CVD) composite (myocardial infarction, acute coronary syndrome, stroke, acute decompensated heart failure, or death from cardiovascular causes), and mortality. Analytical Approach: Linear mixed-effect models were used to evaluate the association between the secretion score and change in eGFR, and Cox proportional hazards models were used to evaluate associations with CKD progression, CVD, and mortality. Results: for interaction < 0.001). Limitations: Persons with diabetes and proteinuria >1 g/d were excluded. Conclusions: Among SPRINT participants with CKD, lower estimated tubular secretion was associated with faster eGFR decline, independent of baseline eGFR and albuminuria, but not with CKD progression, CVD, or mortality.
Source: Kidney Medicine
Institutions: San Francisco VA Medical Center, University of California, San Francisco, San Francisco VA Health Care System, University of California Davis Medical Center, University of California, Davis, University of Washington, University of California San Diego, VA San Diego Healthcare System, Norwegian University of Science and Technology, St Olav's University Hospital, University of Utah, VA Salt Lake City Healthcare System, University of Utah Health Care, Oregon Health & Science University, Portland VA Medical Center, VA Portland Health Care System, University of Minnesota
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,400
Funders: U.S. Department of Veterans Affairs, AstraZeneca, Vanderbilt University, George Washington University, Wake Forest University, University of Minnesota, University of Michigan, University of Florida, University of Utah, University of Washington, Tulane University, University of Pittsburgh, Case Western Reserve University, Norges Teknisk-Naturvitenskapelige Universitet, University of Illinois System, Government of South Australia, National Institutes of Health, University of California, San Diego, Veterans Affairs San Diego Healthcare System, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1037376802, Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G1271685901, G130883262, G1346455397, G1395047820, G1425514332, G1427459792, G1452718737, G1534123016, G1575401839, G1815451664, The Ohio State University Center for Clinical and Translational Science (UL1), G2499961, Tufts Clinical and Translational Research Institute, Kidney Tubular Damage and Dysfunction Identify a Novel Axis of Chronic Kidney Disease, G3042542605, G3370453791, G3604805317, G3606025676, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G417743053, G4559308260, G4823677270, G49760422, G5068655555, G5185313375, G522538789, Institutional Clinical and Translational Science Award, G5473830807, G5679716143, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G644558944, G6760263438, G728281721, G7402001664, G742032275, G7638611195, Institutional Clinical and Translational Science Award, G7738083902, The Vanderbilt Institute for Clinical and Translational Research (VICTR), G7798204357, Clinical and Translational Science Collaborative of Cleveland, G8723760441, G884570035, G8925705019, G94668252
OpenAlex ID: W4296817381