Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

CLINICAL TRIALS

Albuminuria: a target for clinical trials in kidney disease?

A reduction in proteinuria and albuminuria has long been proposed as a surrogate biomarker for clinically validated end points for interventional trials in patients with kidney disease. Taken together, the findings of two recent landmark meta-analyses present a formidable argument favouring such surrogacy but some uncertainty remains.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Cravedi, P. & Remuzzi, G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease Br. J. Clin. Pharmacol. 76, 516–523 (2013).

    PubMed  PubMed Central  Google Scholar 

  2. Eijkelkamp, W. B. et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J. Am. Soc. Nephrol. 18, 1540–1546 (2007).

    Article  CAS  Google Scholar 

  3. Glassock, R. J. Control of albuminuria in overt diabetic nephropathy: durability counts. Nephrol. Dial. Transplant. 31, 1371–1373 (2016).

    Article  CAS  Google Scholar 

  4. Fried, L. F. & Lewis, J. Albuminuria is not an appropriate therapeutic target in patients with CKD: the con view. Clin. J. Am. Soc. Nephrol. 10, 1089–1093 (2015).

    Article  CAS  Google Scholar 

  5. Lambers Heerspink, H. J. & Gansevoort, R. T. Albuminuria is an appropriate therapeutic target in patients with CKD: the pro view. Clin. J. Am. Soc. Nephrol. 10, 1079–1088 (2015).

    Article  Google Scholar 

  6. Coresh, J. et al. Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies. Lancet Diabetes Endocrinol. 7, 115–127 (2019).

    Article  Google Scholar 

  7. Heerspink, H. J. L. et al. Change in albuminuria as a surrogate endpoint for progression of kidney disease: a meta-analysis of treatment effects in randomised clinical trials. Lancet Diabetes Endocrinol. 7, 128–139 (2019).

    Article  Google Scholar 

  8. Inker, L. A. et al. Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis. Am. J. Kidney Dis. 64, 74–85 (2014).

    Article  Google Scholar 

  9. Thompson, A. et al. Proteinuria reduction as a surrogate end point in trials of IgA nephropathy. Clin. J. Am. Soc. Nephrol. https://doi.org/10.2215/CJN.08600718 (2019).

    Article  PubMed  Google Scholar 

  10. Cattran, D. C. et al. The impact of sex in primary glomerulonephritis. Nephrol. Dial. Transplant. 23, 2247–2253 (2008).

    Article  Google Scholar 

Download references

Acknowledgements

The author thanks F. Fervenza (Mayo Clinic, USA) for review of a draft version of this manuscript before submission.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard J. Glassock.

Ethics declarations

Competing interests

R.J.G is a consultant for Bristol-Myers Squibb, Chemocentryx, Apellis, Ionis, Achillion, Omeros and Mallinckrodt. He owns stock in Reata, Inc. (bardoxolone) and receives editorial stipends from Wolters-Kluwer (UpToDate) and Karger Publications (American Journal of Nephrology and Nephrology Viewpoints).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Glassock, R.J. Albuminuria: a target for clinical trials in kidney disease?. Nat Rev Nephrol 15, 257–258 (2019). https://doi.org/10.1038/s41581-019-0123-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41581-019-0123-x

This article is cited by

Search

Quick links

Nature Briefing: Translational Research

Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology, drug discovery and pharma.

Get what matters in translational research, free to your inbox weekly. Sign up for Nature Briefing: Translational Research