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201. Urinary chloride concentration and progression of chronic kidney disease: results from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease

Author

Joo, Young Su, primary, Kim, Jinseok, additional, Park, Cheol Ho, additional, Yun, Hae-Ryong, additional, Park, Jung Tak, additional, Chang, Tae Ik, additional, Yoo, Tae-Hyun, additional, Sung, Su-Ah, additional, Lee, Joongyub, additional, Oh, Kook-Hwan, additional, Kim, Soo Wan, additional, Kang, Shin-Wook, additional, Choi, Kyu Hun, additional, Ahn, Curie, additional, and Han, Seung Hyeok, additional

Published
2019
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204. A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts

Author

Orlandi, Paula F., primary, Huang, Jing, additional, Fukagawa, Masafumi, additional, Hoy, Wendy, additional, Jha, Vivekanand, additional, Oh, Kook-Hwan, additional, Sola, Laura, additional, Cockwell, Paul, additional, Levin, Adeera, additional, Feldman, Harold I., additional, Hoy, Wendy E., additional, Wang, Zaimin, additional, Zhang, Jianzhen, additional, Healy, Helen G., additional, Fenton, Anthony, additional, Orlandi, Paula F., additional, Nessel, Lisa, additional, Go, Alan, additional, Appel, Lawrence, additional, Ahn, Curie, additional, Chae, Dong Wan, additional, Han, Seung Hyeok, additional, Djurdjev, Ognjenka, additional, Tang, Mila, additional, Rios, Pablo G., additional, Gadola, Liliana, additional, Hamano, Takayuki, additional, Fujii, Naohiko, additional, Imaizumi, Takahiro, additional, Yadav, Ashok Kumar, additional, and Kumar, Vivek, additional

Published
2019
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208. Body weight fluctuation is associated with rapid kidney function decline.

Author

Joo, Young Su, Nam, Ki Heon, Jhee, Jong Hyun, Yun, Hae‐Ryong, Lee, Sangmi, Han, Seung Hyeok, Yoo, Tae‐Hyun, Kang, Shin‐Wook, and Park, Jung Tak

Subjects
KIDNEY physiology, BODY weight, GLOMERULAR filtration rate, EPIDERMAL growth factor receptors
Abstract

Objective: This study aimed to evaluate the effects of body weight fluctuations on kidney function deterioration in a prospective cohort of individuals with normal kidney function. Methods: Data were obtained from the Korean Genome and Epidemiology Study. Body weight fluctuations were determined using average successive variability (ASV), which was defined as the average absolute body weight change using repeated measurements for all participants. The decline of the estimated glomerular filtration rate (eGFR) over time was calculated using linear regression analysis of serial eGFR measurements for each patient. Rapid eGFR decline was defined as an average eGFR decline > 3 mL/min/1.73 m2 per year. Results: A total of 6,790 participants were analyzed. During a median follow‐up of 11.7 years, rapid eGFR decline was observed in 913 (13.4%) participants. When the participants were categorized into tertiles according to ASV, rapid eGFR decline was more prevalent in the highest ASV tertile group than in the lowest. Analyses using multiple logistic regression models revealed that the risk of rapid eGFR decline was increased in the highest ASV tertile group compared with the lowest (odds ratio: 1.66). Conclusions: Body weight fluctuations were significantly associated with an increased risk of rapid kidney function decline in participants with normal kidney function. [ABSTRACT FROM AUTHOR]

Published
2022
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209. Low bone mineral density is associated with coronary arterial calcification progression and incident cardiovascular events in patients with chronic kidney disease.

Author

Kim, Hyoungnae, Lee, Joongyub, Lee, Kyu-Beck, Kim, Yeong-Hoon, Hong, Namki, Park, Jung Tak, Han, Seung Hyeok, Kang, Shin-Wook, Choi, Kyu Hun, Oh, Kook-Hwan, and Yoo, Tae-Hyun

Subjects
BONE density, CORONARY artery calcification, CHRONIC kidney failure, MAJOR adverse cardiovascular events, CHRONICALLY ill
Abstract

Background Although it is well known that low bone mineral density (BMD) is associated with an increased risk of cardiovascular disease (CVD) and mortality in the general population, the prognostic role of bone mineral density (BMD) has not been established in the chronic kidney disease (CKD) population. Therefore we aimed to evaluate the association between BMD and the risk of CVD and cardiovascular mortality in patients with predialysis CKD. Methods This prospective cohort study was conducted with 1957 patients with predialysis CKD Stages 1–5. BMD was measured using dual-energy X-ray absorptiometry and coronary arterial calcification (CAC) scores were evaluated using coronary computed tomography. The primary outcome was a major adverse cardiovascular event (MACE). Results When patients were classified based on total hip BMD T -score tertiles stratified by sex, the lowest BMD tertile was significantly associated with an increased risk of MACE {hazard ratio 2.16 [95% confidence interval (CI) 1.25–3.74]; P = 0.006}. This association was also shown with BMD at the femur neck but not with BMD at lumbar spine. In the subgroup of 977 patients with follow-up CACs at their fourth year, 97 (9.9%) showed accelerated CAC progression (>50/year), and BMD was inversely associated with accelerated CAC progression even after adjusting for the baseline CAC score [odds ratio 0.75 (95% CI 0.58–0.99); P = 0.039]. In addition, baseline CAC was associated with an increased risk of MACEs after adjusting for total hip T -score. Conclusions Low BMD was significantly associated with CAC progression and MACEs in patients with predialysis CKD. [ABSTRACT FROM AUTHOR]

Published
2022
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215. Increasing prescription of renin–angiotensin–aldosterone system blockers associated with improved kidney prognosis in Korean IgA nephropathy patients.

Author

Park, Sehoon, Baek, Chung Hee, Park, Su-Kil, Kang, Hee Gyung, Han, Seung Hyeok, Ryu, Dong-Ryeol, Kim, Dong Ki, Oh, Kook-Hwan, Joo, Kwon Wook, Kim, Yon Su, Moon, Kyung Chul, Chin, Ho Jun, and Lee, Hajeong

Subjects
IGA glomerulonephritis, RENIN-angiotensin system, PROGNOSIS, CHRONIC kidney failure, DIAGNOSIS, HYPOTENSION
Abstract

Background We aimed to describe the characteristics of immunoglobulin A nephropathy (IgAN) in Korea with assessment for time trends. Methods We performed a multicenter retrospective observational cohort study including biopsy-confirmed native IgAN cases from four tertiary hospitals in Korea. Time eras of diagnosis were stratified into 1979–2003, 2004–9 and 2010–17. The prognostic variable was progression to end-stage kidney disease (ESKD) analyzed by multivariable Cox regression analysis. Results We included 1366 (from 1979 to 2003), 1636 (from 2004 to 2009) and 1442 (from 2010 to 2017) IgAN patients in this study. In the recent periods, IgAN had relatively better clinical characteristics, as patients had higher estimated glomerular filtration rates and lower baseline blood pressures than before. The use of renin–angiotensin–aldosterone system (RAAS) blockers increased from 57.7% in 1979–2003 to 80.0% in 2010–17. During a median follow-up duration of 11.3 years, 722 patients progressed to ESKD with an incidence rate of 12.5 per 1000 person-years. The 10-year risk of progression to ESKD was lower in 2010–17 compared with that of 1979–2003 [adjusted hazard ratio 0.692 (95% confidence interval 0.523–0.915)], even after adjustment for multiple clinicopathologic characteristics. The use of RAAS blockers was a significant mediator (P < 0.001) for the association between time trends and lower 10-year ESKD risk. Conclusions Clinicopathologic characteristics of IgAN in Korea have changed over time. Although the limitation of a retrospective observational study remains, the result showed that the prognosis of IgAN has improved over the study period, possibly related to increased prescription of RAAS blockers. [ABSTRACT FROM AUTHOR]

Published
2021
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217. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Author

Alencar de Pinho, Natalia, primary, Levin, Adeera, additional, Fukagawa, Masafumi, additional, Hoy, Wendy E., additional, Pecoits-Filho, Roberto, additional, Reichel, Helmut, additional, Robinson, Bruce, additional, Kitiyakara, Chagriya, additional, Wang, Jinwei, additional, Eckardt, Kai-Uwe, additional, Jha, Vivekanand, additional, Oh, Kook-Hwan, additional, Sola, Laura, additional, Eder, Susanne, additional, de Borst, Martin, additional, Taal, Maarten, additional, Feldman, Harold I., additional, Stengel, Bénédicte, additional, Djurdjev, Ognjenka, additional, Tang, Mila, additional, Fujii, Naohiki, additional, Maruyama, Shoichi, additional, Imaizumi, Takahiro, additional, Zhang, Jianzhen, additional, Wang, Zaimin, additional, Healy, Helen G., additional, Alencar de Pinho, Natalia, additional, Massy, Ziad A., additional, Combe, Christian, additional, Laville, Maurice, additional, Filho, Roberto Pecoits, additional, Lopes, Antonio, additional, Pisoni, Ronald, additional, Bieber, Brian, additional, Tu, Charlotte, additional, Sangthawan, Pornpen, additional, Pichaiwong, Warangkana, additional, Klyprayong, Pinkaew, additional, Orlandi, Paula, additional, Townsend, Raymond, additional, Go, Alan, additional, Zhang, Luxia, additional, Kumar, Vivek, additional, Yadav, Ashok Kumar, additional, Baid-Agrawal, Seema, additional, Ahn, Curie, additional, Chae, Dong Wan, additional, Han, Seung Hyeok, additional, Rios, Pablo G., additional, Gadola, Liliana, additional, Lamadrid, Veronica, additional, Leierer, Johannes, additional, Kerschbaum, Julia, additional, de Borst, Martin H., additional, Van Ittersum, Frans J., additional, Van den Brand, Jan A., additional, De Jong, Maarten A., additional, Taal, Maarten W., additional, and Shardlow, Adam, additional

Published
2019
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219. Relationship between complement deposition and the Oxford classification score and their combined effects on renal outcome in immunoglobulin A nephropathy

Author

Park, Seohyun, primary, Kim, Hyung Woo, additional, Park, Jung Tak, additional, Chang, Tae Ik, additional, Kang, Ea Wha, additional, Ryu, Dong-Ryeol, additional, Yoo, Tae-Hyun, additional, Chin, Ho Jun, additional, Jeong, Hyeon Joo, additional, Kang, Shin-Wook, additional, Lim, Beom Jin, additional, and Han, Seung Hyeok, additional

Published
2019
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220. Snoring and incident chronic kidney disease: a community-based prospective cohort study

Author

Lee, Changhyun, primary, Joo, Young Su, additional, Lee, Sangmi, additional, Kang, Shinchan, additional, Kim, Joohwan, additional, Nam, Ki Heon, additional, Yun, Hae-Ryong, additional, Jhee, Jong Hyun, additional, Kim, Hyoungnae, additional, Han, Seung Hyeok, additional, Yoo, Tae-Hyun, additional, Kang, Shin-Wook, additional, and Park, Jung Tak, additional

Published
2019
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227. FP400SMOKING, SMOKING CESSATION, AND PROGRESSION OF CHRONIC KIDNEY DISEASE: From the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD)

Author

Lee, Sangmi, primary, Kang, Shinchan, additional, Lee, Jee Young, additional, Ryu, Geun Woo, additional, Joo, Young Su, additional, Yun, Hae-Ryong, additional, Park, Jung Tak, additional, Han, Seung Hyeok, additional, Yoo, Tae-Hyun, additional, and Kang, Shin-Wook, additional

Published
2019
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236. Secondhand Smoke and CKD

Author

Jhee, Jong Hyun, primary, Joo, Young Su, additional, Kee, Youn Kyung, additional, Jung, Su-Young, additional, Park, Seohyun, additional, Yoon, Chang-Yun, additional, Han, Seung Hyeok, additional, Yoo, Tae-Hyun, additional, Kang, Shin-Wook, additional, and Park, Jung Tak, additional

Published
2019
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238. The effect of interactions between proteinuria, activity of fibroblast growth factor 23 and serum phosphate on renal progression in patients with chronic kidney disease: a result from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease study

Author

Kim, Hyoungnae, primary, Park, Jimin, additional, Nam, Ki Heon, additional, Jhee, Jong Hyun, additional, Yun, Hae-Ryong, additional, Park, Jung Tak, additional, Han, Seung Hyeok, additional, Chung, Wookyung, additional, Oh, Kook-Hwan, additional, Park, Sue Kyung, additional, Kim, Soo Wan, additional, Kang, Shin-Wook, additional, Choi, Kyu Hun, additional, Ahn, Curie, additional, and Yoo, Tae-Hyun, additional

Published
2019
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240. Arterial Stiffness as a Risk Factor for Subclinical Coronary Artery Calcification in Predialysis Chronic Kidney Disease: From the KNOW-CKD Study

Author

Hyun, Young Youl, primary, Kim, Hyang, additional, Oh, Kook-Hwan, additional, Ahn, Curie, additional, Park, Sue K., additional, Chae, Dong Wan, additional, Han, Seung Hyeok, additional, Kim, Yong-Soo, additional, Lee, Sung Woo, additional, Kim, Chang Seong, additional, and Lee, Kyu-Beck, additional

Published
2019
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241. Incidence of Acute Kidney Injury after Adrenalectomy in Patients with Primary Aldosteronism

Author

Lee, Jee Young, primary, Kim, Hyoungnae, additional, Kim, Hyung Woo, additional, Ryu, Geun Woo, additional, Nam, Yooju, additional, Lee, Seonyeong, additional, Joo, Young Su, additional, Lee, Sangmi, additional, Park, Jung Tak, additional, Han, Seung Hyeok, additional, Kang, Shin-Wook, additional, Yoo, Tae-Hyun, additional, and Yun, Hae-Ryong, additional

Published
2019
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242. Clinical Significance of Crescent Formation in IgA Nephropathy – a Multicenter Validation Study

Author

Park, Sehoon , primary, Baek, Chung Hee , additional, Park, Su-Kil , additional, Kang, Hee Gyung , additional, Hyun, Hye Sun , additional, Park, Eujin , additional, Han, Seung Hyeok , additional, Ryu, Dong-Ryeol , additional, Kim, Dong Ki , additional, Oh, Kook-Hwan , additional, Joo, Kwon Wook , additional, Kim, Yon Su , additional, Moon, Kyung Chul , additional, Chin, Ho Jun , additional, and Lee, Hajeong , additional

Published
2019
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243. Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD

Author

Lee, Mi Jung, primary, Chang, Tae Ik, additional, Lee, Joongyub, additional, Kim, Yeong Hoon, additional, Oh, Kook-Hwan, additional, Lee, Sung Woo, additional, Kim, Soo Wan, additional, Park, Jung Tak, additional, Yoo, Tae-Hyun, additional, Kang, Shin-Wook, additional, Choi, Kyu Hun, additional, Ahn, Curie, additional, and Han, Seung Hyeok, additional

Published
2019
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244. Clinical significance of hemodialysis quality of care indicators in very elderly patients with end stage kidney disease

Author

Kim, Hyung Woo, Jhee, Jong Hyun, Joo, Young Su, Yang, Ki Hwa, Jung, Jin Ju, Shin, Ji Hyeon, Han, Seung Hyeok, Yoo, Tae-Hyun, Kang, Shin-Wook, and Park, Jung Tak

Abstract

Introduction: Improvement in life expectancy has increased the number of very elderly patients undergoing hemodialysis. However, it is not clear which quality measures for hemodialysis should be employed in this population. Therefore, in this paper we investigated the association between major adverse cardiovascular and cerebrovascular events (MACCE) indicators of hemodialysis quality in very elderly patients. Patients and Methods: Data regarding a total of 29,692 patients undergoing maintenance hemodialysis (median age 61 years, 41.5% females) who participated in a national hemodialysis quality assessment program were analyzed. They were divided into &lt; 80 years and ≥ 80 years age groups. The primary and secondary outcomes were MACCE and all-cause mortality, respectively. The association between the outcomes and some of the most widely used standard hemodialysis quality-of-care indicators, including spKt/V, hemoglobin, serum calcium, serum phosphate, and albumin levels, was evaluated. To explore the association between Cox proportional hazard models were constructed. Model 1 was adjusted for age and sex. Model 2 included additional demographic characteristics, such as Charlson Comorbidity Index (excluding diabetes), diabetes, cause of ESKD, dialysis vintage, BMI, and pre-dialysis systolic blood pressure. Model 3 was further adjusted for the main medications. To evaluate the relationship between MACCE risk and quality assessment indicators as a continuous variable, cubic spline analyses were conducted. Results: During a median follow-up of 3.7 years, MACCE occurred at a higher rate in the ≥ 80-years group than in the &lt; 80-years group (282.0 vs. 110.1 events/1000 person-years). Multivariate Cox regression analysis revealed that spKt/V, serum calcium and phosphate, and hemoglobin levels were associated with MACCE and all-cause mortality risk in patients aged &lt; 80 years. However, these indicators showed no significant relationship with MACCE and all-cause mortality in patients aged ≥ 80 years. Low serum albumin levels were significantly associated with increased MACCE and all-cause mortality risks, regardless of age. Conclusion: In conclusion, hemodialysis quality-of-care indicators including spKt/V, serum calcium and phosphate levels, and hemoglobin were not related to MACCE or all-cause mortality in very elderly hemodialysis patients. However, lower serum albumin levels were associated with poor outcomes, regardless of patient age. Assuring nutritional status rather than improving hemodialysis management adequacy may be more beneficial for improving outcomes in very elderly hemodialysis patients. Further prospective evaluations are needed to confirm these findings.

Published
2022
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245. Differential effects of arterial stiffness and fluid overload on blood pressure according to renal function in patients at risk for cardiovascular disease

Author

Park, Seohyun, primary, Lee, Chan Joo, additional, Lee, Misol, additional, Cha, Min-Uk, additional, An, Seong Yeong, additional, Nam, Ki Heon, additional, Jhee, Jong Hyun, additional, Yun, Hae-Ryong, additional, Kim, Hyoungnae, additional, Kee, Youn Kyung, additional, Park, Jung Tak, additional, Kim, Hyeon Chang, additional, Yoo, Tae-Hyun, additional, Kang, Shin-Wook, additional, Park, Sungha, additional, and Han, Seung Hyeok, additional

Published
2018
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246. Severe vitamin D deficiency is a risk factor for renal hyperfiltration

Author

Jhee, Jong Hyun, primary, Nam, Ki Heon, additional, An, Seong Yeong, additional, Cha, Min-Uk, additional, Lee, Misol, additional, Park, Seohyun, additional, Kim, Hyoungnae, additional, Yun, Hae-Ryong, additional, Kee, Youn Kyung, additional, Park, Jung Tak, additional, Han, Seung Hyeok, additional, Kang, Shin-Wook, additional, and Yoo, Tae-Hyun, additional

Published
2018
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247. Effects of Coffee Intake on Incident Chronic Kidney Disease: A Community-Based Prospective Cohort Study

Author

Jhee, Jong Hyun, primary, Nam, Ki Heon, additional, An, Seong Yeong, additional, Cha, Min-Uk, additional, Lee, Misol, additional, Park, Seohyun, additional, Kim, Hyoungnae, additional, Yun, Hae-Ryong, additional, Kee, Youn Kyung, additional, Park, Jung Tak, additional, Chang, Tae-Ik, additional, Kang, Ea Wha, additional, Yoo, Tae-Hyun, additional, Kang, Shin-Wook, additional, and Han, Seung Hyeok, additional

Published
2018
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248. Association between the transtubular potassium gradient and progression of chronic kidney disease: results from KNOW-CKD

Author

Lee, Seon Yeong, Park, Jung Tak, Joo, Young Su, Yoo, Tae-Hyun, Lee, Joongyub, Chung, Wookyung, Kim, Yong-Soo, Kim, Soo Wan, Oh, Kook-Hwan, Ahn, Curie, Kang, Shin-Wook, Choi, Kyu Hun, and Han, Seung Hyeok

Abstract

Background: The transtubular potassium gradient which reflects potassium secretion by the kidney through the cortical collecting duct, has not yet been tested as a surrogate marker of kidney function decline. Here, we investigate the relationship between the transtubular potassium gradient and chronic kidney disease (CKD) progression. Methods: We studied 1672 patients from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) cohort. The transtubular potassium gradient was calculated using a standard equation. The study endpoint was CKD progression, defined as a composite of a ≥ 50% decrease in estimated glomerular filtration rate (eGFR) from baseline values or end-stage kidney disease. Results: During a median follow-up of 4.1 years (7149 person-years), 441 participants reached the endpoint. In cause-specific competing risk analysis, the highest tertile was associated with a significantly lower risk of an adverse kidney outcome compared with the lowest tertile [hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.55–0.97]. When the transtubular potassium gradient was treated as a continuous variable, an increase of 1 in the transtubular potassium gradient was associated with a 6% lower risk of CKD progression (95% CI, 0.90–0.99). This association was particularly evident in patients with an eGFR ≥ 45 mL/min/1.73 m2. A time-updated transtubular potassium gradient model showed similar results. The predictive performance of the transtubular potassium gradient was significantly less than that of the eGFR, but similar to that of proteinuria, serum bicarbonate, and urine osmolality. Conclusions: A higher transtubular potassium gradient is associated with a significantly lower risk of CKD progression, suggesting that it may offer insights into the prognosis of CKD. Graphic abstract:

Published
2021
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249. CD71 mesangial IgA1 receptor and the progression of IgA nephropathy.

Author

Jhee, Jong Hyun, Nam, Bo Young, Park, Jung Tak, Kim, Hyung Woo, Chang, Tae Ik, Kang, Ea Wha, Lim, Beom Jin, Yoo, Tae-Hyun, Kang, Shin-Wook, Jeong, Hyeon Joo, and Han, Seung Hyeok

Abstract

The transferrin receptor (CD71) is known as a receptor for IgA1 on mesangial cells, but the role of CD71 in IgA nephropathy (IgAN) is unknown. We studied clinical implication of mesangial CD71 in 282 patients with biopsy-proven IgAN (2005-2018). The transcript and protein expression of glomerular CD71 was determined by real-time polymerase chain reaction and immunohistochemistry. Ten subjects with microscopic hematuria only and no evidence of histologic abnormalities on kidney biopsy were considered as controls. Human mesangial cells (HMCs) were treated with sera from IgAN patients and expression levels of CD71 and inflammatory cytokine markers were compared according to disease status. Disease progression was defined as a ≥30% decline in estimated glomerular filtration rate from the baseline value. During a mean follow up of 53.5 (18.3-75.9) months, 80 (28.4%) patients developed disease progression. The mRNA expression of CD71 was significantly higher in progressors than in nonprogressors (P = 0.001). Among the Oxford classification scores, patients with M1 had significantly higher CD71 expression levels than those with M0. In a multivariable Cox model, elevated transcript levels of CD71 were significantly associated with 4.32-fold higher risk of disease progression (P = 0.009). Furthermore, CD71 expression levels independently predicted the increase in proteinuria of ≥50% from the baseline (P = 0.03). Finally, HMCs treated with sera from IgAN patients with the higher Oxford score (M1E1S1T0) more increased the mRNA expression of CD71 and inflammatory markers than those with sera from negative score (M0E0S0T0). However, silencing CD71 significantly reduced expression levels of the inflammatory cytokine genes. Our results show that mesangial CD71 is significantly associated with disease progression and may play a biologic role in IgAN. [ABSTRACT FROM AUTHOR]

Published
2021
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250. Urinary chloride concentration and progression of chronic kidney disease: results from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease.

Author

Joo, Young Su, Kim, Jinseok, Park, Cheol Ho, Yun, Hae-Ryong, Park, Jung Tak, Chang, Tae Ik, Yoo, Tae-Hyun, Sung, Su-Ah, Lee, Joongyub, Oh, Kook-Hwan, Kim, Soo Wan, Kang, Shin-Wook, Choi, Kyu Hun, Ahn, Curie, and Han, Seung Hyeok

Subjects
CHRONIC kidney failure, CHRONICALLY ill, KIDNEY tubules, CHLORIDES, COHORT analysis
Abstract

Background Urinary chloride is regulated by kidney transport channels, and high urinary chloride concentration in the distal tubules can trigger tubuloglomerular feedback. However, little attention has been paid to urinary chloride as a biomarker of clinical outcomes. Here, we studied the relationship between urinary chloride concentration and chronic kidney disease (CKD) progression. Methods We included 2086 participants with CKD from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease. Patients were categorized into three groups, according to baseline urinary chloride concentration tertiles. The study endpoint was a composite of ≥50% decrease in estimated glomerular filtration rate from baseline values, or end-stage kidney disease. Results During a median follow-up period of 3.4 years (7452 person-years), 565 participants reached the primary endpoint. There was a higher rate of CKD progression events in the lowest and middle tertiles than in the highest tertile. Compared with the lowest tertile, the highest tertile was associated with 33% [95% confidence interval (CI) 0.49–0.90] lower risk for the primary outcome in a cause-specific hazard model after adjustment for confounding variables. In addition, for every 25 mEq/L increase in urinary chloride concentration, there was 11% (95% CI 0.83–0.96) lower risk for CKD progression. This association was consistent in a time-varying model. Urinary chloride concentration correlated well with tubule function and kidney injury markers, and its predictive performance for CKD progression was comparable to that of these markers. Conclusions In this hypothesis-generating study, low urinary chloride concentration was associated with a higher risk for CKD progression. [ABSTRACT FROM AUTHOR]

Published
2021
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