PROTEINURIA AND BLOOD-PRESSURE AS CAUSAL COMPONENTS OF PROGRESSION TOEND-STAGE RENAL-FAILURE

Aims. To identify the prognostic factors possibly related to end-stage renal failure development. Subjects and methods. The prognostic facto rs affecting chronic renal failure progression were analysed in 456 pa tients who had participated in a formal, multicentre, prospective rand omized trial aimed at verifying the role of protein restriction in slo wing down or halting the progression of chronic renal failure. The 24- month follow-up foreseen by the protocol was completed by 311 patients and 69 reached an end-point. An inductive analysis on patient surviva l was made by using the Cox proportional hazard regression model, usin g a stepwise procedure in order to select only those factors which are significantly associated with survival. For each individual risk fact or, a univariate descriptive analysis of survival was performed using the Kaplan-Meier technique. Results. Underlying nephropathy, baseline plasma creatinine, proteinuria, and plasma calcium were all shown to b e related to end-stage renal failure onset. Hypertensive patients (mea n blood pressure > 107 mmHg) had a worst cumulative renal survival but the degree of proteinuria was even more important as a prognostic fac tor of renal death than hypertension. The cumulative renal survival of patients whose proteinuria decreased during the trial follow-up was b etter than those of patients without changes. However, the interaction between baseline lying mean blood pressure and proteinuria was not si gnificant. Conclusions. Only primary renal disease and proteinuria wer e related to renal survival, being baseline plasma creatinine confound ing factor. By blocking the possible causal role of proteinuria and hy pertension, end-stage renal failure could be prevented in a significan t percentage of patients.