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Clinical significance of urinary liver-type fatty acid-binding protein as a predictor of ESRD and CVD in patients with CKD

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Abstract

Background

To improve outcomes in patients with chronic kidney disease (CKD), it is important to identify prognostic factors for end-stage renal disease (ESRD) as well as cardiovascular disease (CVD). This study assessed urinary concentrations of albumin, N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP), as predictors of ESRD and CVD.

Methods

A prospective, observational, multicenter study, comprising 244 Japanese outpatients with CKD who had a follow-up period of at least 3 months. The primary endpoint was the first onset of a nonfatal or fatal CVD event and progression to ESRD, defined as myocardial infarction, stroke, or artery revascularization (coronary, carotid or peripheral), and initiation of dialysis.

Results

During a median follow-up of 3.8 years, the primary endpoint occurred in 39 (15.8 %) patients. Irrespective of diabetes, high urinary L-FABP correlated with the development of ESRD and CVD. The areas under the receiver-operator characteristic curves (AUCs) for predicting the primary endpoint for urinary concentrations of L-FABP, albumin, and NAG were 0.825, 0.797, and 0.722, respectively. Cox regression analyses, which were adjusted for factors known to influence the primary endpoint, including patient characteristics, and serum and urinary parameters, demonstrated that the primary outcome was associated with high urinary L-FABP and low eGFR [p = 0.049, hazard ratio = 1.341 (95 % CI 1.005–1.790); and p < 0.000, hazard ratio = 0.953 (95 % CI 0.930–0.976), respectively].

Conclusions

Urinary L-FABP may be a useful prognostic marker of progression to ESRD and the onset of CVD in patients with CKD.

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Acknowledgments

We wish to thank Ms. Kimie Katayama, and Aya Sakamaki, Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, Ms. Seiko Hoshino, Department of Anatomy, St. Marianna University School of Medicine, for collection of urine. This study was partly supported by Grant-in-Aids for Diabetic Nephropathy Research and for Diabetic Nephropathy and Nephrosclerosis Research, which were provided by the Ministry of Health, Labor and Welfare of Japan and the Ministry of Education, Science, Sports and Culture, Japan.

Conflict of interest

T. Sugaya is the Director and Senior scientist of CMIC Holdings Co., Ltd., the company that produced the kits for L-FABP analysis. None of the other authors have conflicts of interest or financial disclosures of any relevance to the present study.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kawasaki, Kanagawa, Japan

    Katsuomi Matsui & Naohiko Imai

  2. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, 216-8511, Kanagawa, Japan

    Katsuomi Matsui, Atsuko Kamijo-Ikemori, Naohiko Imai, Takeshi Sugaya, Takashi Yasuda, Yugo Shibagaki & Kenjiro Kimura

  3. Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Atsuko Kamijo-Ikemori

  4. The Unit of Medical Statistics, Faculty of Medical Education and Culture, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Shinobu Tatsunami

  5. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan

    Tadashi Toyama, Miho Shimizu, Kengo Furuichi & Takashi Wada

  6. Department of Internal Medicine, Tokyo Takanawa Hospital, Tokyo, Japan

    Kenjiro Kimura

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  1. Katsuomi Matsui
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Corresponding author

Correspondence to Yugo Shibagaki.

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Cite this article

Matsui, K., Kamijo-Ikemori, A., Imai, N. et al. Clinical significance of urinary liver-type fatty acid-binding protein as a predictor of ESRD and CVD in patients with CKD. Clin Exp Nephrol 20, 195–203 (2016). https://doi.org/10.1007/s10157-015-1144-9

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  • DOI: https://doi.org/10.1007/s10157-015-1144-9

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