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Urinary chloride concentration and progression of chronic kidney disease: results from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease

Authors
 Young Su Joo  ;  Jinseok Kim  ;  Cheol Ho Park  ;  Hae-Ryong Yun  ;  Jung Tak Park  ;  Tae Ik Chang  ;  Tae-Hyun Yoo  ;  Su-Ah Sung  ;  Joongyub Lee  ;  Kook-Hwan Oh  ;  Soo Wan Kim  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Curie Ahn  ;  Seung Hyeok Han 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.36(4) : 673-680, 2021-03 
Journal Title
 NEPHROLOGY DIALYSIS TRANSPLANTATION 
ISSN
 0931-0509 
Issue Date
2021-03
Keywords
CKD progression ; urine chloride
Abstract
Background: Urinary chloride is regulated by kidney transport channels, and high urinary chloride concentration in the distal tubules can trigger tubuloglomerular feedback. However, little attention has been paid to urinary chloride as a biomarker of clinical outcomes. Here, we studied the relationship between urinary chloride concentration and chronic kidney disease (CKD) progression. Methods: We included 2086 participants with CKD from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease. Patients were categorized into three groups, according to baseline urinary chloride concentration tertiles. The study endpoint was a composite of ≥50% decrease in estimated glomerular filtration rate from baseline values, or end-stage kidney disease. Results: During a median follow-up period of 3.4 years (7452 person-years), 565 participants reached the primary endpoint. There was a higher rate of CKD progression events in the lowest and middle tertiles than in the highest tertile. Compared with the lowest tertile, the highest tertile was associated with 33% [95% confidence interval (CI) 0.49-0.90] lower risk for the primary outcome in a cause-specific hazard model after adjustment for confounding variables. In addition, for every 25 mEq/L increase in urinary chloride concentration, there was 11% (95% CI 0.83-0.96) lower risk for CKD progression. This association was consistent in a time-varying model. Urinary chloride concentration correlated well with tubule function and kidney injury markers, and its predictive performance for CKD progression was comparable to that of these markers. Conclusions: In this hypothesis-generating study, low urinary chloride concentration was associated with a higher risk for CKD progression.
Full Text
https://academic.oup.com/ndt/article/36/4/673/5680038
DOI
10.1093/ndt/gfz247
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Park, Cheol Ho(박철호) ORCID logo https://orcid.org/0000-0003-4636-5745
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Joo, Young Su(주영수) ORCID logo https://orcid.org/0000-0002-7890-0928
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182304
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