Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD

Mi Jung Lee, Tae Ik Chang, Joongyub Lee, Yeong Hoon Kim, Kook Hwan Oh, Sung Woo Lee, Soo Wan Kim, Jung Tak Park, Tae Hyun Yoo, Shin Wook Kang, Kyu Hun Choi, Curie Ahn, Seung Hyeok Han

Research output: Contribution to journalArticle

Abstract

Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.

Original languageEnglish
Pages (from-to)1089-1100
Number of pages12
JournalKidney and Blood Pressure Research
Volume44
Issue number5
DOIs
Publication statusPublished - 2019 Oct 1

Fingerprint

Chronic Renal Insufficiency
Osmolar Concentration
Urine
Kidney
Glomerular Filtration Rate
Disease Progression
Confidence Intervals
Vasopressins
Kidney Transplantation
Dialysis

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Mi Jung ; Chang, Tae Ik ; Lee, Joongyub ; Kim, Yeong Hoon ; Oh, Kook Hwan ; Lee, Sung Woo ; Kim, Soo Wan ; Park, Jung Tak ; Yoo, Tae Hyun ; Kang, Shin Wook ; Choi, Kyu Hun ; Ahn, Curie ; Han, Seung Hyeok. / Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease : Results from the KNOW-CKD. In: Kidney and Blood Pressure Research. 2019 ; Vol. 44, No. 5. pp. 1089-1100.
@article{158909fef2a24f83bbf0664a0e560335,
title = "Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD",
abstract = "Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50{\%} decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6{\%}) patients; 240 (36.4{\%}), 162 (24.3{\%}), and 30 (4.5{\%}) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95{\%} confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95{\%} CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.",
author = "Lee, {Mi Jung} and Chang, {Tae Ik} and Joongyub Lee and Kim, {Yeong Hoon} and Oh, {Kook Hwan} and Lee, {Sung Woo} and Kim, {Soo Wan} and Park, {Jung Tak} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Curie Ahn and Han, {Seung Hyeok}",
year = "2019",
month = "10",
day = "1",
doi = "10.1159/000502291",
language = "English",
volume = "44",
pages = "1089--1100",
journal = "Kidney and Blood Pressure Research",
issn = "1420-4096",
publisher = "S. Karger AG",
number = "5",

}

Lee, MJ, Chang, TI, Lee, J, Kim, YH, Oh, KH, Lee, SW, Kim, SW, Park, JT, Yoo, TH, Kang, SW, Choi, KH, Ahn, C & Han, SH 2019, 'Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD', Kidney and Blood Pressure Research, vol. 44, no. 5, pp. 1089-1100. https://doi.org/10.1159/000502291

Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease : Results from the KNOW-CKD. / Lee, Mi Jung; Chang, Tae Ik; Lee, Joongyub; Kim, Yeong Hoon; Oh, Kook Hwan; Lee, Sung Woo; Kim, Soo Wan; Park, Jung Tak; Yoo, Tae Hyun; Kang, Shin Wook; Choi, Kyu Hun; Ahn, Curie; Han, Seung Hyeok.

In: Kidney and Blood Pressure Research, Vol. 44, No. 5, 01.10.2019, p. 1089-1100.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease

T2 - Results from the KNOW-CKD

AU - Lee, Mi Jung

AU - Chang, Tae Ik

AU - Lee, Joongyub

AU - Kim, Yeong Hoon

AU - Oh, Kook Hwan

AU - Lee, Sung Woo

AU - Kim, Soo Wan

AU - Park, Jung Tak

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Ahn, Curie

AU - Han, Seung Hyeok

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.

AB - Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12-2.59). This association was particularly evident in patients with CKD stages 3-4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00-1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.

UR - http://www.scopus.com/inward/record.url?scp=85072204367&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072204367&partnerID=8YFLogxK

U2 - 10.1159/000502291

DO - 10.1159/000502291

M3 - Article

C2 - 31505490

AN - SCOPUS:85072204367

VL - 44

SP - 1089

EP - 1100

JO - Kidney and Blood Pressure Research

JF - Kidney and Blood Pressure Research

SN - 1420-4096

IS - 5

ER -