Association Between New-Onset Proteinuria During Hospitalization and Cardiovascular Mortality Among Patients With...

Evidence regarding the prognostic value of new-onset proteinuria during hospitalization among patients with atherosclerotic cardiovascular disease (ASCVD) is lacking.

We aimed to examine the associations of new-onset proteinuria during hospitalization with cardiovascular (CV) mortality and composite kidney outcomes after discharge.

This observational cohort study included hospitalized adults with ASCVD and without proteinuria at admission from twenty-four academic hospitals participated in China Renal Data System. New-onset proteinuria during hospitalization was defined as a change in urinary protein test from negative to 1+ or more. The primary outcome was CV mortality after discharge. The secondary outcome was the composite of adverse kidney outcomes including sustained new-onset estimated glomerular filtration rate <60 mL/min/1.73 m², >40% decline in estimated glomerular filtration rate, or end stage renal disease. The associations between new-onset proteinuria and outcomes were assessed by Cox proportional hazard models.

In this nationwide cohort of 34,429 inpatients with the mean age of 64 years, new-onset proteinuria occurred in 7.5% of the population. With a mean follow-up of 4.6 years, new-onset proteinuria during hospitalization was significantly associated with an increased risk of CV mortality (HR: 1.30; 95% CI: 1.07-1.57) and adverse kidney outcomes (HR: 1.50; 95% CI: 1.04-2.17). The association between new-onset proteinuria and CV mortality was independent of the occurrence of acute kidney injury and showed similar trend across subgroups and multiple sensitivity analyses.

The presence of new-onset proteinuria during hospitalization among ASCVD patients demonstrated significant prognostic value and should be carefully monitored to improve patient care.