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Relación entre la función renal, la proteinuria y los resultados adversos
Brenda R Hemmelgarn1, Braden J Manns, Anita Lloyd
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada. brenda.hemmelgarn@albertahealthservices.ca
JAMA
|February 4, 2010
Resumen
La proteinuria aumenta significativamente el riesgo de resultados adversos como la muerte y la insuficiencia renal, incluso con una función renal normal (eGFR). Esto pone de relieve la necesidad de incorporar la proteinuria en las evaluaciones de riesgo de enfermedad renal crónica para un mejor manejo del paciente.
Área de la Ciencia:
- Nefrología Nefrología.
- Cardiología Cardiología.
- Salud Pública La salud pública.
Sus antecedentes:
- La estadificación actual de la enfermedad renal crónica (ERC) se basa en la tasa de filtración glomerular estimada (eGFR), pero no integra la proteinuria para la estratificación del riesgo.
- La proteinuria se asocia de forma independiente con resultados clínicos adversos en pacientes con ERC.
Objetivo del estudio:
- Investigar la asociación combinada de la reducción de la GFR y la proteinuria con resultados clínicos adversos.
- Para determinar si la proteinuria modifica el riesgo asociado con los niveles de eGFR en una población adulta general.
Principales métodos:
- Un estudio de cohorte basado en la comunidad de 920.985 adultos en Alberta, Canadá (2002-2007).
- Se utilizaron datos del registro de laboratorio para las mediciones del eGFR y la proteinuria (medidor de orina o relación albúmina-creatinina [ACR]).
- Resultados evaluados que incluyen mortalidad por cualquier causa, infarto de miocardio y progresión de insuficiencia renal.
Principales resultados:
- Los niveles más altos de proteinuria se asociaron con mayores tasas de mortalidad por cualquier causa, infarto de miocardio e insuficiencia renal, independientemente del eGFR.
- Los individuos con proteinuria pesada y eGFR ≥ 60 ml/min/1.73 m2 tenían más del doble del riesgo de mortalidad en comparación con aquellos con eGFR moderado y sin proteinuria.
- Se observaron asociaciones similares para ACR y otros resultados adversos como la enfermedad renal en etapa terminal.
Conclusiones:
- La proteinuria es un predictor independiente de los resultados adversos en la ERC.
- El riesgo de mortalidad, infarto de miocardio e insuficiencia renal se amplifica por niveles más altos de proteinuria en cualquier eGFR dado.
- Las directrices clínicas deben considerar la incorporación de la evaluación de la proteinuria para una estratificación completa del riesgo de ERC.
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