Nephrol Dial Transplant (1996) 11: 461-467
© 1996 European Renal Association-European Dialysis and Transplant Association
research-article
Proteinuria and blood pressure as causal components of progression to end-stage renal failure
1Division of Nephrology, Ospedale di Lecco Lecco 2Istituto Scienze Sanitarie Applicate, Università di Pavia Pavia 3Ciba Medical Department Origgio 4Division of Nephrology, IRCCS, Ospedale Maggiore-Croff Milano 5Division of Nephrology, IRCCS, Ospedale Maggiore-Granelli Milano 6Division of Nephrology, Ospedale S. Gerardo de' Tintori Monza 7Division of Nephrology, Ospedale Provinciale Busto Arsizio, Italy
Correspondence and offprint requests to: Correspondence and offprint requests to: Prof. Francesco Locatelli, Divisione Nefrologia e Dialisi, Ospedale di Lecco, via Ghislanzoni 22, 22053 Lecco, Italy
AIMS.: To identify the prognostic factors possibly related to end-stage renal failure development.
SUBJECTS AND METHODS.: The prognostic factors affecting chronic renal failure progression were analysed in 456 patients who had participated in a formal, multicentre, prospective randomized trial aimed at verifying the role of protein restriction in slowing down or halting the progression of chronic renal failure. The 24-month follow-up foreseen by the protocol was completed by 311 patients and 69 reached an end-point. An inductive analysis on patient survival was made by using the Cox proportional hazard regression model, using a stepwise procedure in order to select only those factors which are significantly associated with survival. For each individual risk factor, a univariate descriptive analysis of survival was performed using the Kaplan-Meier technique.
RESULTS.: Underlying nephropathy, baseline plasma creatinine, proteinuria, and plasma calcium were all shown to be related to end-stage renal failure on-set. Hypertensive patients (mean blood pressure>107 mmHg) had a worst cumulative renal survival but the degree of proteinuria was even more important as a prognostic factor of renal death than hypertension. The cumulative renal survival of patients whose proteinuria decreased during the trial follow-up was better than those of patients without changes. However, the interaction between baseline lying mean blood pressure and proteinuria was not significant.
CONCLUSIONS.: Only primary renal disease and proteinuria were related to renal survival, being baseline plasma creatinine confounding factor. By blocking the possible causal role of proteinuria and hypertension, end-stage renal failure could be prevented in a significant percentage of patients.
Keywords: blood pressure; end-stage renal failure; proteinuria; hypertension; prognostic factors; multi-centre; prospective randomized trial
* Participating centres: Nephrology Department of Hospital of Lecco (P. Marai, F. Tentori, D. Marcelli, R. Ponti, F. Locatelli), Milano Policlinico-Croff (G. Graziani, G. Ambroso, A. Aroldi, C. Ponticelli), Milano-S. Carlo (MG. Gentile, M. G. Manna, G. D'Amico), Milano Policlinico-Granelli (D. Cresseri, M Lorenz, G. Buccianti), Monza (M. R. Viganò, G. Bonoldi, B. Redaelli), Busto Arsizio (A. Castiglioni, A. Giangrande), Varese (D. Donati, L. Gastaldi), Milano- S. Paolo (G. Como, R. Silenzio, D. Brancaccio), Bergamo (E. Gotti, G. Mecca), Desio (B. Dozio, G. Cairo), Vimercate (F. Conte, M. Meroni, A. Sessa), Pavia-Clinica del Lavoro (L. Picardi, G. Villa, A. Salvadeo), Lodi (P. Cosci, M. Surian), Crema (C. Depetri, M. Mileti), Melegnano (O. Bracchi, B. Giraldi, C. Grassi), Pinerolo (E. Reina, U. Malcangi, A. Ramello), Mantova (M. Baruffaldi, C. Baroni), Novara (G. E. Guida, G. Verzetti), Cinisello (A. Costantino, F. Vallino), Brescia-Umberto I (S. Bassi, P. Poiatti, A. Castellani), Modena (G. Gaiani, E. Lusvarghi), Ciba Medical Department Origgio (D. Alberti, B. M. Francucci, G. Battirossi). Steering Committee: F. Locatelli (Chairman), D. Alberti, M. G. Gentile, G. Graziani, G. Buccianti, G. Cairo, P. Cosci.
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