Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Northern Italian Cooperative Study Group

Nephrol Dial Transplant. 1996 Mar;11(3):461-7. doi: 10.1093/ndt/11.3.461.


Aims: To identify the prognostic factors possibly related to end-stage renal failure development.

Subjects and methods: The prognostic factors affecting chronic renal failure progression were analysed in 456 patients who had participated in a formal, multicentre, prospective randomized trial aimed at verifying the role of protein restriction in slowing 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 survival was made by using the Cox proportional hazard regression model, using a stepwise procedure in order to select only those factors which are significantly associated with survival. For each individual risk factor, 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 be related to end-stage renal failure onset. Hypertensive patients (mean blood pressure > 107 mmHg) had a worst cumulative renal survival but the degree of proteinuria was even more important as a prognostic factor of renal death than hypertension. The cumulative renal survival of patients whose proteinuria decreased during the trial follow-up was better than those of patients without changes. However, the interaction between baseline lying mean blood pressure and proteinuria was not significant.

Conclusions: Only primary renal disease and proteinuria were related to renal survival, being baseline plasma creatinine confounding factor. By blocking the possible causal role of proteinuria and hypertension, end-stage renal failure could be prevented in a significant percentage of patients.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Pressure*
  • Creatinine / blood
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / blood
  • Hypertension / complications*
  • Hypertension / physiopathology
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / etiology*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prospective Studies
  • Proteinuria / blood
  • Proteinuria / complications*
  • Proteinuria / physiopathology
  • Risk Factors
  • Survival Rate


  • Creatinine