{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:18:02Z","timestamp":1791605882809,"version":"4.3.4"},"reference-count":46,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Nephrol"],"abstract":"<jats:p>Introduction: Kidney injury molecule-1 (KIM-1) expression reflects proximal renal tubular damage, but plasma and urine KIM-1 have not been jointly studied in a CKD cohort. Methods: Plasma and urine KIM-1 were measured in 2,581 adults from the NURTuRE-CKD cohort, a multicentre, non-dialysis-dependent CKD cohort. Survival analyses, C-statistics, and net reclassification improvement were used to assess associations and predictive performance of plasma and urine KIM-1 for kidney failure (KF), all-cause mortality, and a secondary endpoint of combined CKD progression endpoint (CKE) (KF or &gt;40% decline in eGFR) in the total cohort and in KDIGO albuminuria categories, early CKD (eGFR &gt;45 mL\/min\/1.73 m2), and four plasma\/urine KIM-1 groups, dichotomised above and below the median value. Results: Median age was 65 years, baseline eGFR 34.8 mL\/min\/1.73 m2, and urine albumin-to-creatinine ratio (uACR) 22.3 mg\/mmol. During median follow-up of 48.8 months, 616 (23.9%) participants developed KF, 817 (32%) experienced CKE, and 344 (13.3%) died. Plasma and urine KIM-1 levels increased with lower eGFR, higher uACR, and diabetes. Plasma KIM-1 was independently associated with KF, while urine KIM-1 was associated with pre-KF death. The combination of high plasma and high urine KIM-1 conferred the greatest hazards of KF and all-cause mortality. Combining plasma and urine KIM-1 led to a 24.1% improvement in net reclassification index for KF. In earlier stages of CKD, both biomarkers were associated with CKD progression and there were large improvements in risk prediction for plasma KIM-1 alone. Increased albuminuria amplified the relationship between plasma and urine KIM-1 and KF risk. Conclusion: This study highlights distinct prognostic associations of plasma and urine KIM-1 in CKD. Measuring both may be useful in improving risk stratification in people with CKD. For early-stage CKD, the need to use a combined CKE, including decline in eGFR, is emphasised as few of these people developed KF. <\/jats:p>","DOI":"10.1159\/000547867","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T16:02:34Z","timestamp":1754928154000},"page":"1-14","source":"Crossref","is-referenced-by-count":19,"title":["Plasma and Urinary KIM-1 in Chronic Kidney Disease: Prognostic Value, Associations with Albuminuria, and Implications for Kidney Failure and Mortality"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2898-4457","authenticated-orcid":false,"given":"Thomas","family":"McDonnell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"S\u00f6derberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten 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