Association between urinary free light chains and progression to end stage renal disease in chronic kidney disease.

Fenton, Anthony and Jesky, Mark D and Webster, Rachel and Stringer, Stephanie J and Yadav, Punit and Chapple, Iain and Dasgupta, Indranil and Harding, Stephen J and Ferro, Charles J and Cockwell, Paul (2018) Association between urinary free light chains and progression to end stage renal disease in chronic kidney disease. PloS one, 13 (5). e0197043. ISSN 1932-6203. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Abstract

BACKGROUND

Patients with chronic kidney disease (CKD) are at an increased risk of developing end-stage renal disease (ESRD). We assessed for the first time whether urinary free light chains (FLC) are independently associated with risk of ESRD in patients with CKD, and whether they offer incremental value in risk stratification.

MATERIALS AND METHODS

We measured urinary FLCs in 556 patients with CKD from a prospective cohort study. The association between urinary kappa/creatinine (KCR) and lambda/creatinine (LCR) ratios and development of ESRD was assessed by competing-risks regression (to account for the competing risk of death). The change in C-statistic and integrated discrimination improvement were used to assess the incremental value of adding KCR or LCR to the Kidney Failure Risk Equation (KFRE).

RESULTS

136 participants developed ESRD during a median follow-up time of 51 months. Significant associations between KCR and LCR and risk of ESRD became non-significant after adjustment for estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR), although having a KCR or LCR >75th centile remained independently associated with risk of ESRD. Neither KCR nor LCR as continuous or categorical variables provided incremental value when added to the KFRE for estimating risk of ESRD at two years.

CONCLUSIONS

Urinary FLCs have an association with progression to ESRD in patients with CKD which appears to be explained to a degree by their correlation with eGFR and ACR. Levels above the 75th centile do have an independent association with ESRD, but do not improve upon a current model for risk stratification.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
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Depositing User: Mrs Semanti Chakraborty
Date Deposited: 18 May 2018 12:35
Last Modified: 18 May 2018 12:35
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1656

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