{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:43Z","timestamp":1786480243557,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["R38HL155729"],"award-info":[{"award-number":["R38HL155729"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["R38HL155729"],"award-info":[{"award-number":["R38HL155729"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,11]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Clinicians may repeat proteinuria measurements multiple times but may overlook the significance of temporal patterns of proteinuria.<\/jats:p>\n <\/jats:list-item>\n \n Trajectory analyses identified four discrete proteinuria subgroups: low-slowly rising, high-slowly rising, regressing, and rapidly rising.<\/jats:p>\n <\/jats:list-item>\n \n Trajectories of proteinuria identify subgroups of patients with CKD who have increased risks of ESKD and death independent of known risk factors.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Despite repeating proteinuria measurements multiple times during the clinical course of a patient with CKD, clinicians may overlook the significance of temporal patterns of proteinuria. In addition, it is unclear whether proteinuria trajectories identify subpopulations with varying risks of adverse clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We used group-based trajectory modeling to identify proteinuria trajectories on the basis of annual urine protein\u2013creatinine ratio (UPCR) measurements in 3209 participants of the Chronic Renal Insufficiency Cohort study who were alive and did not reach ESKD within 3 years of study entry. Multivariable-adjusted Cox proportional hazards models tested the associations of UPCR trajectories with ESKD and death in those who survived beyond the third annual visit.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Trajectory analyses identified four discrete groups on the basis of annual UPCR measurements: low-slowly rising (\n n<\/jats:italic>\n =1528), high-slowly rising (\n n<\/jats:italic>\n =1363), regressing (\n n<\/jats:italic>\n =114), and rapidly rising (\n n<\/jats:italic>\n =204). Compared with the low-slowly rising proteinuria trajectory group, participants in the other proteinuria trajectory groups had lower socioeconomic status, a greater prevalence of comorbid conditions, and lower eGFR. During a median follow-up of 8.6 years, 547 participants progressed to ESKD, and 836 participants died. Compared with the low-slowly rising group, all proteinuria trajectory groups were associated with higher risks of subsequent ESKD, but only the high-slowly rising group was associated with a higher risk of death.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Trajectories of repeated proteinuria measurements identify subgroups of patients with CKD who have increased risks of ESKD and death independent of known risk factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000849","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T12:00:39Z","timestamp":1750939239000},"page":"1890-1898","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Associations of Proteinuria Trajectories with Kidney Failure and Death in Individuals with CKD"],"prefix":"10.34067","volume":"6","author":[{"given":"Avi G.","family":"Aronov","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-6327","authenticated-orcid":false,"given":"Ashish","family":"Verma","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8670-3644","authenticated-orcid":false,"given":"Ana C.","family":"Ricardo","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7348-4451","authenticated-orcid":false,"given":"Tanika N.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-326X","authenticated-orcid":false,"given":"Sushrut S.","family":"Waikar","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6580-4080","authenticated-orcid":false,"given":"James P.","family":"Lash","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8109-1420","authenticated-orcid":false,"given":"Anand","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CRIC Study Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"issue":"15","key":"B1-20251120","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJMra1808786","article-title":"Insights into glomerular filtration and albuminuria","volume":"384","author":"Benzing","year":"2021","journal-title":"N Engl J Med."},{"issue":"12","key":"B2-20251120","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1038\/ki.2010.550","article-title":"Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts","volume":"79","author":"Astor","year":"2011","journal-title":"Kidney Int."},{"issue":"11","key":"B3-20251120","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1681\/ASN.2006040377","article-title":"How does proteinuria cause progressive renal damage?","volume":"17","author":"Abbate","year":"2006","journal-title":"J Am Soc Nephrol."},{"issue":"13","key":"B4-20251120","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":"Grams","year":"2023","journal-title":"JAMA."},{"issue":"6","key":"B5-20251120","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the american heart association's prevent equations","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation."},{"issue":"1","key":"B6-20251120","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1053\/j.ajkd.2021.03.021","article-title":"Time-updated changes in estimated GFR and proteinuria and major adverse cardiac events: findings from the Chronic Renal Insufficiency Cohort (CRIC) study","volume":"79","author":"Cohen","year":"2022","journal-title":"Am J Kidney Dis."},{"issue":"2","key":"B7-20251120","doi-asserted-by":"crossref","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."},{"issue":"2","key":"B8-20251120","doi-asserted-by":"crossref","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."},{"issue":"1","key":"B9-20251120","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1053\/j.ajkd.2014.02.020","article-title":"Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis","volume":"64","author":"Inker","year":"2014","journal-title":"Am J Kidney Dis."},{"issue":"7 suppl 2","key":"B10-20251120","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1097\/01.ASN.0000070149.78399.CE","article-title":"The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods","volume":"14","author":"Feldman","year":"2003","journal-title":"J Am Soc Nephrol."},{"issue":"8","key":"B11-20251120","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.2215\/CJN.00070109","article-title":"Chronic Renal Insufficiency Cohort (CRIC) study: baseline characteristics and associations with kidney function","volume":"4","author":"Lash","year":"2009","journal-title":"Clin J Am Soc Nephrol."},{"issue":"5","key":"B12-20251120","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1159\/000296250","article-title":"Variability of creatinine measurements in clinical laboratories: results from the CRIC study","volume":"31","author":"Joffe","year":"2010","journal-title":"Am J Nephrol."},{"issue":"19","key":"B14-20251120","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C\u2013based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med."},{"issue":"1","key":"B15-20251120","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1146\/annurev.clinpsy.121208.131413","article-title":"Group-based trajectory modeling in clinical research","volume":"6","author":"Nagin","year":"2010","journal-title":"Annu Rev Clin Psychol."},{"issue":"2","key":"B16-20251120","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v078.i02","article-title":"Estimation of extended mixed models using latent classes and latent processes: the R package lcmm","volume":"78","author":"Proust-Lima","year":"2017","journal-title":"J Stat Soft."},{"issue":"7","key":"B17-20251120","doi-asserted-by":"crossref","first-page":"e020683","DOI":"10.1136\/bmjopen-2017-020683","article-title":"Framework to construct and interpret latent class trajectory modelling","volume":"8","author":"Lennon","year":"2018","journal-title":"BMJ Open."},{"issue":"10","key":"B18-20251120","first-page":"7593","article-title":"Latent class trajectory modelling: impact of changes in model specification","volume":"14","author":"Watson","year":"2022","journal-title":"Am J Transl Res."},{"issue":"3","key":"B19-20251120","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/10705511.2016.1247646","article-title":"The GRoLTS-checklist: guidelines for reporting on latent trajectory studies","volume":"24","author":"Van De Schoot","year":"2017","journal-title":"Struct Equ Modeling."},{"issue":"3","key":"B20-20251120","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"mice: multivariate imputation by chained equations in R","volume":"45","author":"Buuren","year":"2011","journal-title":"J Stat Soft."},{"issue":"Pt 6","key":"B22-20251120","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1258\/acb.2009.009001","article-title":"Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease","volume":"46","author":"Guy","year":"2009","journal-title":"Ann Clin Biochem."},{"issue":"4","key":"B23-20251120","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1053\/j.ajkd.2018.04.023","article-title":"Biological variability of estimated GFR and albuminuria in CKD","volume":"72","author":"Waikar","year":"2018","journal-title":"Am J Kidney Dis."},{"key":"B24-20251120","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/978-981-13-8871-2_24","article-title":"New understanding on the role of proteinuria in progression of chronic kidney disease","volume":"1165","author":"Liu","year":"2019","journal-title":"Adv Exp Med Biol."},{"key":"B25-20251120","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000324943","article-title":"Pathogenesis and progression of proteinuria","volume":"170","author":"Thomas","year":"2011","journal-title":"Contrib Nephrol."},{"issue":"1","key":"B26-20251120","doi-asserted-by":"crossref","first-page":"e002241","DOI":"10.1136\/bmjdrc-2021-002241","article-title":"Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: a nationwide cohort study of biopsy-proven diabetic kidney disease","volume":"9","author":"Yamanouchi","year":"2021","journal-title":"BMJ Open Diabetes Res Care."},{"issue":"2","key":"B27-20251120","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1001\/jamacardio.2019.4867","article-title":"Association of longitudinal trajectory of albuminuria in young adulthood with myocardial structure and function in later life: coronary artery risk development in young adults (CARDIA) study","volume":"5","author":"Patel","year":"2020","journal-title":"JAMA Cardiol."},{"issue":"9854","key":"B28-20251120","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(12)61350-6","article-title":"Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis","volume":"380","author":"Fox","year":"2012","journal-title":"Lancet."},{"issue":"9731","key":"B29-20251120","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/S0140-6736(10)60674-5","article-title":"Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis","volume":"375","author":"Matsushita","year":"2010","journal-title":"Lancet."},{"issue":"6","key":"B30-20251120","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/j.kint.2016.01.012","article-title":"Podocyte injury and its consequences","volume":"89","author":"Nagata","year":"2016","journal-title":"Kidney Int."},{"issue":"3","key":"B31-20251120","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1046\/j.1523-1755.1998.00044.x","article-title":"Progression of glomerular diseases: is the podocyte the culprit?","volume":"54","author":"Kriz","year":"1998","journal-title":"Kidney Int."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000849","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:59:30Z","timestamp":1786478370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000849"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":29,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000000849","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]},"assertion":[{"value":"2024-12-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-05","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}