Proteinuria, a marker of cardiovascular risks

The presence of CKD is a powerful predictor of adverse clinical outcomes.2,3 cardiovascular disease is by far the most common cause of death in dialysis-dependent and renal transplant patients. Only a small minority of the CKD population progress to endstage renal disease requiring renal replacement therapy (RRT), with death prior to RRT being far more common. A 2010 meta-analysis with data for over 1 million subjects reported that stage 3 CKD (eGFR<60mL/ minute/1.73m2) was associated with both cardiovascular and allcause mortality.4 In a systematic review of associations between non-dialysis-dependent CKD and mortality, Tonelli et al reported that the absolute risk of death increased exponentially with declining renal function.5 Even the earliest, clinically silent stages of CKD have been associated with major cardiovascular disease. In addition to reduced eGFR, ACR and dipstick positive proteinuria have also been associated with graded cardiovascular and all-cause mortality, acting as risk multipliers across all levels of renal function.6,7 In a large Canadian study, Hemmelgarn et al found that heavy proteinuria independently increased risk of death, myocardial infarction (MI) and progression of CKD in particular patient groups.8