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Updated: May 17, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Interaction between GFR and risk factors for morbidity and mortality in African Americans with CKD
Kevin F Erickson1, Janice Lea, William M McClellan
1Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94304, USA. kevine1@stanford.edu
Insights
Proteinuria significantly predicts chronic kidney disease (CKD) progression, end-stage renal disease, or death, especially in patients with lower glomerular filtration rates (GFR). This highlights a high-risk group needing closer monitoring.
Area of Science:
- Nephrology
- Clinical Epidemiology
- Public Health
Background:
- The African American Study of Kidney Disease Trial identified key risk factors for chronic kidney disease (CKD) progression.
- Previous findings suggested that glomerular filtration rate (GFR) level might influence the relationship between risk factors and CKD progression or mortality.
Purpose of the Study:
- To investigate whether the association between previously identified risk factors for CKD progression (or death) and a composite clinical outcome depends on the level of GFR.
- To determine if GFR modifies the impact of risk factors on CKD progression, end-stage renal disease (ESRD), or death.
Main Methods:
- Analysis of data from 1094 patients with hypertensive kidney disease enrolled in the African American Study of Kidney Disease Trial (1995-2001).
- Median follow-up of 48.6 months.
- Multivariate Cox regression models were used to assess the association between six risk factors and a composite outcome (CKD progression, ESRD, or death), controlling for baseline risk factors and testing for GFR interaction.
Main Results:
- Proteinuria was the only factor significantly associated with the composite clinical outcome at lower GFR levels (P=0.002 for interaction).
- Doubling proteinuria increased the hazard of the composite outcome by 30% (95% CI, 21%-39%) at GFR 50, and by 55% (95% CI, 40%-72%) at GFR 25.
Conclusions:
- The impact of proteinuria on CKD progression, ESRD, or death is dependent on GFR level.
- Proteinuria is a stronger independent predictor of adverse outcomes in patients with lower GFR.
- African Americans with proteinuria and lower GFR represent a high-risk population for adverse kidney disease outcomes.
Background And Objectives:
The African American Study of Kidney Disease Trial identified risk factors for CKD progression and suggested that GFR level may modify the association between these risk factors and CKD progression or death.
Design, Setting, Participants, & Measurements:
Enrollment in the African American Study of Kidney Disease Trial occurred between June of 1995 and September of 2001, with median follow-up of 48.6 months. Among 1094 patients with hypertensive kidney disease in the trial, this study tested whether the association between six previously identified risk factors for CKD progression (or death) and a composite clinical outcome (progression of CKD, ESRD, or death) depends on level of GFR. Multivariate Cox regression was used to control for other baseline risk factors.
Results:
After controlling for baseline risk factors, only proteinuria was more closely associated with the composite clinical outcome at lower levels of GFR (P value for interaction term=0.002); increased hazards of the clinical composite outcome associated with a doubling of proteinuria ranged from 30% (95% confidence interval=21%-39%) with a GFR of 50 to 55% (95% confidence interval=40%-72%) with a GFR of 25.
Conclusions:
The magnitude of the association between proteinuria and CKD progression, ESRD, or death in the African American Study of Kidney Disease Trial cohort depends on the level of GFR; proteinuria is a stronger independent predictor of the composite clinical outcome at lower levels of GFR. This finding reinforces that African Americans with proteinuria and lower GFR represent a population at particularly high risk for adverse outcomes.
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