FP334PROGRESSION OF ALBUMINURIA IN PERSONS WITH EARLY STAGE CHRONIC KIDNEY DISEASE
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Albuminuria is a powerful predictor of adverse outcomes in persons with chronic kidney disease (CKD) such that even small increases are associated with substantial additional risk. Regular monitoring for albuminuria is therefore recommended but has proven difficult to achieve, possibly due to uncertainty about benefit. Little is known about the pattern of progression of albuminuria over time in early stage CKD. We therefore sought to investigate the progression of albuminuria over 5 years in a large cohort of persons with CKD stage 3 recruited from primary care practices, where most such patients are managed in the UK. METHODS: Participants with estimated GFR 59-30mL/min/1.73m2 were prospectively recruited from primary care practices and comprehensively assessed at baseline, year 1 and 5. Albuminuria was assessed at each study visit as the average albumin to creatinine ratio (UACR) on three consecutive early morning urine specimens. Albuminuria was defined as UACR >3mg/mmol. We investigated associations with new onset albuminuria and change in the magnitude of albuminuria over 5 years. RESULTS: We studied 1738 persons with mean age 72.9±9.0y and eGFR 53.5±11.8ml/min/1.73m2; 60.5% were female, 16.8% had diabetes and 97.6% were of white ethnicity. The prevalence of albuminuria increased from 17.1% at baseline to 18.3% at Year-1 and 27.3% at Year-5 (p<0.001). Of 1050 participants without albuminuria at baseline, 182 (17.3%) developed albuminuria by Year-5 (approximately 3.5% per year). Of 186 participants with albuminuria at baseline, 32 (17.2%) no longer had albuminuria at Year-5. Binary logistic regression analysis identified male sex, greater age and lower values for each of eGFR, haemoglobin, serum bicarbonate, body mass index and vitamin D levels as independent risk factors for new onset albuminuria (Nagelkerke R2=0.23). Among 186 participants with albuminuria at baseline, the median UACR increased from 7.6 (4.2 to 16.1) mg/mmol to 8.0 (3.6 to 18.1) at Year-1 and 13.1 (5.7 to 30.4) at Year-5 (p<0.001 for baseline vs. Year-5). Univariable analysis identified male sex, diabetes, lower serum bicarbonate, greater body weight and body mass index and change in UACR at Year-1 as determinants of the magnitude of increase in UACR at Year-5 but only weight, UACR at baseline and change in UACR at Year-1 were independent determinants on multivariable analysis (Adjusted R2=0.12). CONCLUSIONS: Albuminuria was observed in only a minority of participants but the prevalence and magnitude increased over 5 years. Our findings emphasize the need for annual monitoring of albuminuria even in persons with early stage CKD. Risk factors identified indicate that males, older persons and those with diabetes, obesity or lower GFR should be targeted for improved monitoring.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".