{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:41:15Z","timestamp":1786372875988,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2018,12]]},"abstract":"\n Background and objectives<\/jats:title>\n Whether patients with monoclonal protein are at a higher risk for progression of kidney disease is not known. The goal of this study was to measure the association of monoclonal protein with progression to ESKD.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n This was a retrospective cohort study of 2,156,317 patients who underwent serum creatinine testing between October 1, 2000 and September 30, 2001 at a Department of Veterans Affairs medical center, among whom 21,898 had paraprotein testing within 1 year before or after cohort entry. Progression to ESKD was measured using linked data from the US Renal Data System.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 1,741,707 cohort members had an eGFR\u226560 ml\/min per 1.73 m\n 2<\/jats:sup>\n , 283,988 had an eGFR of 45\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n , 103,123 had an eGFR of 30\u201344 ml\/min per 1.73 m\n 2<\/jats:sup>\n and 27,499 had an eGFR of 15\u201329 ml\/min per 1.73 m\n 2<\/jats:sup>\n . The crude incidence of ESKD ranged from 0.7 to 80 per 1000 person-years from the highest to lowest eGFR category. Patients with low versus preserved eGFR were more likely to be tested for monoclonal protein but no more likely to have a positive test result. In adjusted analyses, a positive versus negative test result was associated with a higher risk of ESKD among patients with an eGFR\u226560 ml\/min per 1.73 m\n 2<\/jats:sup>\n (hazard ratio, 1.67; 95% confidence interval, 1.22 to 2.29) and those with an eGFR of 15\u201329 ml\/min per 1.73 m\n 2<\/jats:sup>\n (hazard ratio, 1.38; 95% confidence interval, 1.07 to 1.77), but not among those with an eGFR of 30\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n .<\/jats:sub>\n Progression to ESKD was attributed to a monoclonal process in 21 out of 76 versus seven out of 174 patients with monoclonal protein and preserved versus severely reduced eGFR at cohort entry.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The detection of monoclonal protein provides little information on ESKD risk for most patients with a low eGFR. Further study is required to better understand factors contributing to a positive association of monoclonal protein with ESKD risk in patients with preserved and severely reduced levels of eGFR.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.06210518","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T11:11:01Z","timestamp":1542280261000},"page":"1810-1815","source":"Crossref","is-referenced-by-count":8,"title":["Association of Monoclonal Gammopathy with Progression to ESKD among US Veterans"],"prefix":"10.2215","volume":"13","author":[{"given":"Nicholas","family":"Burwick","sequence":"first","affiliation":[{"name":"Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington;"},{"name":"Department of Medicine, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott V.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Todd-Stenberg","sequence":"additional","affiliation":[{"name":"Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilka Rios","family":"Burrows","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meda E.","family":"Pavkov","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"O\u2019Hare","sequence":"additional","affiliation":[{"name":"Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington;"},{"name":"Department of Medicine, University of Washington, Seattle, Washington; 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