{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:45:50Z","timestamp":1782715550933,"version":"3.54.5"},"reference-count":26,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CKD"},{"DOI":"10.13039\/501100016099","name":"JAC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016099","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>The urinary albumin-to-creatinine ratio (UACR) is an established surrogate endpoint for kidney failure in chronic kidney disease (CKD). However, proteinuria remains widely used in routine clinical practice in several countries due to its accessibility and cost-effectiveness. Moreover, the comparative utility of UACR and proteinuria as surrogate endpoints is not well-defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the Chronic Kidney Disease Japan Cohort to examine the association between a 30% decrease in urinary protein-to-creatinine ratio (UPCR) or UACR over 2 years and the subsequent risk of kidney failure requiring replacement therapy (KFRT). We also examined the relationship between a 30% decrease in UPCR over 1 year and the risk of KFRT. Associations were evaluated using multivariable Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 2966 patients, 603 had both UACR and UPCR data available over 2 years. Their mean age was 60 years, mean estimated glomerular filtration rate (eGFR) was 29\u00a0ml\/min\/1.73 m\u00b2, median UPCR was 0.81\u00a0g\/gCr, and median UACR was 601\u00a0mg\/gCr. During a median follow-up of 4.9 years, 245 patients (40.6%) progressed to KFRT. A 30% decrease in UPCR over 2 years was significantly associated with a lower risk of KFRT [hazard ratio (HR), 0.52 (0.38, 0.71)], with comparable findings for UACR [HR, 0.58 (0.41, 0.82)]. A similar association was observed for UPCR over 1 year among 831 patients [HR 0.56 (0.43, 0.73)]. Subgroup analyses showed consistent associations across most baseline characteristics. Nevertheless, the association of UPCR change was weaker than that of UACR change in patients with eGFR &amp;lt; 15\u00a0ml\/min\/1.73 m\u00b2, possibly reflecting the reduced urinary albumin-to-protein ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with CKD, a 30% decrease in UPCR or UACR over 2 years may serve as a comparable surrogate endpoint for subsequent KFRT. Nonetheless, caution is warranted in patients with eGFR &amp;lt; 15\u00a0ml\/min\/1.73 m\u00b2.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag122","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:21:31Z","timestamp":1779794491000},"source":"Crossref","is-referenced-by-count":0,"title":["Urinary protein vs albumin for assessing kidney failure risk in chronic kidney disease"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0162-6286","authenticated-orcid":false,"given":"Tadashi","family":"Toyama","sequence":"first","affiliation":[{"name":"Department of Nephrology, Faculty of Medical Sciences, University of Fukui , Yoshida-gun ,","place":["Japan"]},{"name":"Department of Nephrology and Rheumatology, Kanazawa University , Kanazawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Imaizumi","sequence":"additional","affiliation":[{"name":"Department of Advanced Medicine, Nagoya University Hospital , Nagoya ,","place":["Japan"]},{"name":"Department of Nephrology, Nagoya University Graduate School of Medicine , Nagoya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2100-9106","authenticated-orcid":false,"given":"Takayuki","family":"Hamano","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya City University Graduate School of Medicine , Nagoya ,","place":["Japan"]},{"name":"Department of Nephrology, The University of Osaka Graduate School of Medicine , Suita ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotaka","family":"Komaba","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine , Isehara ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiko","family":"Fujii","sequence":"additional","affiliation":[{"name":"Medical and Research Center for Nephrology and Transplantation, Hyogo Prefectural Nishinomiya Hospital , Nishinomiya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0420-5583","authenticated-orcid":false,"given":"Takeshi","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, Showa Medical University , Tokyo ,","place":["Japan"]},{"name":"Department of Nephrology\/Department of Hygiene, Public Health, and Preventive Medicine, Graduate School of Medicine, Showa Medical University , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Advanced Medicine, Nagoya University Hospital , Nagoya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7401-2934","authenticated-orcid":false,"given":"Masaomi","family":"Nangaku","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Endocrinology, The University of Tokyo Hospital , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosaku","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Tokyo Women\u2019s Medical University, Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0820-7167","authenticated-orcid":false,"given":"Yoshitaka","family":"Isaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The University of Osaka Graduate School of Medicine , Suita ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Rheumatology, Kanazawa University , Kanazawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-632X","authenticated-orcid":false,"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya University Graduate School of Medicine , Nagoya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7832-2339","authenticated-orcid":false,"given":"Masafumi","family":"Fukagawa","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine , Isehara ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062902014293000_bib1","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1681\/ASN.2014040396","article-title":"Assessing the validity of surrogate outcomes for ESRD: a meta-analysis","volume":"26","author":"Jun","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"2026062902014293000_bib2","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1681\/ASN.2019010007","article-title":"GFR slope as a surrogate end point for kidney disease progression in clinical trials: a meta-analysis of treatment effects of randomized controlled trials","volume":"30","author":"Inker","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"2026062902014293000_bib3","doi-asserted-by":"publisher","first-page":"sfae398","DOI":"10.1093\/ckj\/sfae398","article-title":"Clinically meaningful eGFR slope as a surrogate endpoint differs across CKD stages and slope evaluation periods: the CKD-JAC study","volume":"18","author":"Imaizumi","year":"2025","journal-title":"Clin Kidney J"},{"key":"2026062902014293000_bib4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/kisup.2012.64","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Chapter 1: definition and classification of CKD","volume":"3","year":"2013","journal-title":"Kidney Int Suppl"},{"key":"2026062902014293000_bib5","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/j.1440-1797.2010.01314.x","article-title":"Proteinuria versus albuminuria in chronic kidney disease","volume":"15","author":"Guh","year":"2010","journal-title":"Nephrology"},{"key":"2026062902014293000_bib6","first-page":"77","article-title":"Change in proteinuria or albuminuria as a surrogate for cardiovascular and other major clinical outcomes: a systematic review and meta-analysis","volume":"35","author":"Harrison","year":"2019","journal-title":"Can J Cardiol"},{"key":"2026062902014293000_bib7","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1291\/hypres.31.1101","article-title":"Chronic kidney disease Japan cohort (CKD-JAC) study: design and methods","volume":"31","author":"Imai","year":"2008","journal-title":"Hypertens Res"},{"key":"2026062902014293000_bib8","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1053\/j.ajkd.2008.12.034","article-title":"Revised equations for estimated GFR from serum creatinine in Japan","volume":"53","author":"Matsuo","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"2026062902014293000_bib9","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"key":"2026062902014293000_bib10","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression Modeling Strategies","author":"Harrell","year":"2015","edition":"2 ed."},{"key":"2026062902014293000_bib11","doi-asserted-by":"publisher","first-page":"2430","DOI":"10.1002\/sim.5647","article-title":"A unified inference procedure for a class of measures to assess improvement in risk prediction systems with survival data","volume":"32","author":"Uno","year":"2013","journal-title":"Stat Med"},{"key":"2026062902014293000_bib12","article-title":"PMCALPLOT: Stata module to produce calibration plot of prediction model performance","volume-title":"Statistical Software Components S458486","author":"Ensor","year":"2018"},{"key":"2026062902014293000_bib13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1053\/j.ajkd.2019.06.009","article-title":"Change in albuminuria and GFR as end points for clinical trials in early stages of CKD: a scientific workshop sponsored by the National Kidney Foundation in Collaboration with the US Food and Drug Administration and European Medicines Agency","volume":"75","author":"Levey","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2026062902014293000_bib14","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/S2213-8587(18)30313-9","article-title":"Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies","volume":"7","author":"Coresh","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026062902014293000_bib15","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.kint.2016.09.037","article-title":"Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality","volume":"91","author":"Carrero","year":"2017","journal-title":"Kidney Int"},{"key":"2026062902014293000_bib16","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1001\/jama.2023.17002","article-title":"Estimated glomerular filtration rate, albuminuria, and adverse outcomes: an individual-participant data meta-analysis","volume":"330","author":"Writing Group for the CKDPC","year":"2023","journal-title":"JAMA"},{"key":"2026062902014293000_bib17","doi-asserted-by":"publisher","first-page":"426","DOI":"10.7326\/M20-0529","article-title":"Conversion of urine protein-creatinine ratio or urine dipstick protein to urine albumin-creatinine ratio for use in chronic kidney disease screening and prognosis : an individual participant-based meta-analysis","volume":"173","author":"Sumida","year":"2020","journal-title":"Ann Intern Med"},{"key":"2026062902014293000_bib18","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1681\/ASN.2019060605","article-title":"Estimating urine albumin-to-creatinine ratio from protein-to-creatinine ratio: development of equations using same-day measurements","volume":"31","author":"Weaver","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"2026062902014293000_bib19","doi-asserted-by":"publisher","first-page":"32","DOI":"10.7326\/ANNALS-25-02117","article-title":"Proteinuria or albuminuria as markers of kidney and cardiovascular disease risk : an individual patient-level meta-analysis","volume":"179","author":"Heerspink","year":"2026","journal-title":"Ann Intern Med"},{"key":"2026062902014293000_bib20","article-title":"Unveiling the hidden power of uromodulin: a promising potential biomarker for kidney diseases","volume":"13:3077","author":"Thielemans","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"2026062902014293000_bib21","doi-asserted-by":"publisher","first-page":"12123","DOI":"10.3390\/ijms222212123","article-title":"Urinary protein and peptide markers in chronic kidney disease","volume":"22","author":"Chebotareva","year":"2021","journal-title":"Int J Mol Sci"},{"key":"2026062902014293000_bib22","doi-asserted-by":"publisher","first-page":"2507","DOI":"10.1056\/NEJMoa2110730","article-title":"Chlorthalidone for hypertension in advanced chronic kidney disease","volume":"385","author":"Agarwal","year":"2021","journal-title":"N Engl J Med"},{"key":"2026062902014293000_bib23","article-title":"Product catalog\u2014urinary protein and albumin assay kits","author":"BioAssay Systems"},{"key":"2026062902014293000_bib24","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/jdi.14293","article-title":"The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese patients with type 2 diabetes","volume":"16","author":"Asahi","year":"2025","journal-title":"J Diabetes Invest"},{"key":"2026062902014293000_bib25","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s10157-024-02600-9","article-title":"The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese non-diabetic patients","volume":"29:","author":"Konta","year":"2025;","journal-title":"Clin Exp Nephrol"},{"key":"2026062902014293000_bib26","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/S2213-8587(18)30314-0","article-title":"Change in albuminuria as a surrogate endpoint for progression of kidney disease: a meta-analysis of treatment effects in randomised clinical trials","volume":"7","author":"Heerspink","year":"2019","journal-title":"Lancet Diabetes Endocrinol"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfag122\/68631432\/gfag122.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfag122\/68631432\/gfag122.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:01:47Z","timestamp":1782712907000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article\/doi\/10.1093\/ndt\/gfag122\/8719400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":26,"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfag122","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"article-number":"gfag122"}}