PREVALENCE OF PROTEINURIA AND ITS RISK FACTORS IN RELATIVES OF CHRONIC KIDNEY DISEASE PATIENTS RECEIVING RENAL REPLACEMENT THERAPY AT EAST AVENUE MEDICAL CENTER: CROSS-SECTIONAL STUDY

Chronic kidney disease (CKD) is a progressive and irreversible condition characterized by a steady decline in renal function that can culminate in end-stage renal disease (ESRD), requiring dialysis or kidney transplantation. It represents a global public health challenge, with approximately 850 million people affected worldwide (Jager and Kovesdy, 2019; Luyckx et al., 2020). The increasing prevalence of CKD contributes substantially to healthcare expenditures, morbidity, and premature mortality, emphasizing the need for early detection and preventive care (Hill et al., 2016).

Among the earliest and most reliable markers of kidney injury is proteinuria, defined as the abnormal excretion of protein in the urine (Levey et al., 2003). Proteinuria is not merely a marker but also a mediator of renal damage, contributing to glomerular and tubulointerstitial injury. It strongly predicts CKD progression and cardiovascular complications (Glassock, 2010). Detecting proteinuria in high-risk groups enables timely interventions that can slow CKD progression and improve long-term outcomes (Ene-Iordache et al., 2016).

A particularly high-risk group includes first-degree relatives of CKD patients, who share both genetic predisposition and environmental exposures that increase susceptibility to kidney injury (Patel et al., 2019). Studies have shown that familial clustering of CKD is common, suggesting that both heritable factors and shared household determinants—such as dietary habits, toxin exposure, and socioeconomic conditions—play synergistic roles (Satko et al., 2005). In this context, screening relatives of patients undergoing renal replacement therapy (RRT) becomes an effective approach for identifying subclinical kidney injury before symptoms develop.

The urinary albumin-to-creatinine ratio (UACR) is a well-validated, simple, and cost-effective test for detecting early kidney damage (Matsushita et al., 2020). Measured in a random spot urine sample, it quantifies albumin concentration relative to creatinine, with thresholds defined as normal (<30 mg/g), moderately increased (30–299 mg/g), and severely increased (≥300 mg/g) (KDIGO, 2021). UACR not only serves as a diagnostic marker but also correlates with cardiovascular risk and long-term renal outcomes (Peralta et al., 2011). Its convenience and predictive value make it suitable for population-level screening, particularly in resource-constrained settings such as the Philippines.

Previous international studies have consistently demonstrated an elevated prevalence of proteinuria among relatives of CKD patients. In China, Chen et al. (2014) found albuminuria in 14.4% of first-degree relatives of dialysis patients, compared with 8.4% in controls, indicating significant familial aggregation. Similarly, Alwakeel et al. (2012) reported a 26.5% prevalence among Saudi relatives, while Ulasi et al. (2014) observed an even higher rate of 37% in Nigeria. These studies collectively highlight the substantial familial burden of kidney disease and underscore the need for early detection in high-risk families.

Traditional CKD risk factors—such as hypertension, diabetes mellitus, obesity, and metabolic syndrome—are prevalent among these relatives and act synergistically to amplify renal risk (Khalil et al., 2018). In Malaysia, Lim et al. (2017) demonstrated that individuals with diabetes had an odds ratio (OR) of 2.63 for proteinuria, while those with hypertension had an OR of 2.49. These associations emphasize the importance of controlling metabolic and vascular risk factors to prevent CKD onset in genetically predisposed populations.

Interestingly, environmental and lifestyle influences may also extend the familial risk beyond genetic ties. In a case-control study, Xu et al. (2018) reported that 41.1% of spouses of dialysis patients—who share no genetic relationship—had CKD, compared to 15.8% of controls, implicating shared household exposures such as dietary sodium intake, water quality, and medication practices. These findings support a holistic, family-centered approach to CKD prevention.

Despite CKD being among the top causes of morbidity and mortality in the Philippines, local data on the prevalence of proteinuria among relatives of CKD patients remain scarce. Given that CKD often progresses silently until advanced stages, population-based screening using UACR could offer a practical and effective strategy for early identification and intervention. This study therefore aimed to determine the prevalence of proteinuria and its associated risk factors among relatives of CKD patients undergoing RRT at East Avenue Medical Center (EAMC) in Quezon City. By providing local evidence, the study seeks to inform family-based screening programs and guide public health strategies aimed at curbing CKD progression in the Filipino population.

This observational cross-sectional study was conducted at the East Avenue Medical Center (EAMC) in Quezon City during the second and third quarters of 2025 to determine the prevalence of proteinuria and its associated risk factors among first- to third-degree relatives of chronic kidney disease (CKD) patients undergoing renal replacement therapy (RRT), including both hemodialysis and peritoneal dialysis. Eligible participants were biologically related to index CKD patients, aged 18 years or older, and provided written informed consent in accordance with ethical standards and institutional review board approval. Individuals who were non-Filipino, step-relatives, or unable to provide reliable information due to cognitive impairment were excluded. Recruitment was carried out in the dialysis unit and outpatient clinics, aligned with the ACT NOW campaign of Diabetes Philippines promoting early detection of cardiovascular and renal risks. Each participant underwent a structured interview and physical assessment that included measurement of height, weight, and body mass index (BMI), as well as collection of demographic data, medical history (hypertension, diabetes, dyslipidemia, cardiovascular disease), and lifestyle information such as smoking, obesity, and use of nephrotoxic medications. A random spot urine sample was obtained and analyzed using an AVE urine analyzer to determine the urinary albumin-to-creatinine ratio (UACR), with proteinuria defined as UACR ≥30 mg/g based on Kidney Disease: Improving Global Outcomes (KDIGO, 2021) criteria. Descriptive statistics summarized participant characteristics, while differences between groups with and without proteinuria were assessed using the independent samples t-test for continuous variables and the chi-square or Fisher’s exact test for categorical variables. Logistic regression analysis was employed to identify independent predictors of proteinuria, calculating odds ratios (OR) and 95% confidence intervals (CI), with statistical significance set at p<0.05. Data management and analysis were performed using Microsoft Excel and STATA version 13.1, and all analyses were two-tailed with missing data left unestimated to preserve data integrity.

A total of 167 relatives of CKD patients on RRT participated in the study (Table 1). The overall prevalence of proteinuria was 37% (61/167). The mean participant age was 41 years, with no significant difference between those with and without proteinuria (38.5 ± 16.4 vs. 42.0 ± 14.9 years, p=0.154). Sex distribution was balanced (male: 32.8% vs. 36.8%, p=0.602).

Participants with proteinuria had a significantly higher mean body weight (64.5 ± 13.8 kg vs. 60.4 ± 11.5 kg, p=0.042). BMI was modestly higher in the proteinuria group (25.6 ± 5.3 vs. 24.3 ± 4.4 kg/m²), though not statistically significant (p=0.085). Degree of kinship (first-, second-, or third-degree) did not significantly differ between groups.

Hypertension emerged as the most frequent comorbidity among proteinuric relatives (49.2% vs. 32.1%, p=0.029), while diabetes, dyslipidemia, and cardiovascular diseases showed no significant associations. When traditional CKD risk factors were evaluated collectively, hypertension remained the strongest predictor (55.7% vs. 34.9%, p=0.009). The absence of any CKD risk factor was notably less common among those with proteinuria (9.8% vs. 26.4%, p=0.010).

Logistic regression analysis reinforced these findings (Table 2). Each additional kilogram of body weight increased the odds of proteinuria by 2.7% (OR 1.0266; 95% CI 1.0004–1.0535; p=0.047). Participants with hypertension had twice the oddsof proteinuria compared to non-hypertensives (OR 2.0493; 95% CI 1.0733–3.9129; p=0.030). When self-reported CKD risk factors were considered, hypertension remained a significant independent predictor (OR 2.3483; 95% CI 1.2333–4.4715; p=0.009). Conversely, the absence of CKD risk factors was protective (OR 0.3039; 95% CI 0.1179–0.7833; p=0.014).

These findings demonstrate a clear association between hypertension, elevated body weight, and the presence of proteinuria, highlighting the need for early risk-based interventions in this high-risk group.

This study revealed that proteinuria was prevalent in 37% of first- to third-degree relatives of CKD patients on RRT at East Avenue Medical Center. Hypertension emerged as the strongest and most consistent risk factor, approximately doubling the likelihood of proteinuria. Higher body weight was also associated with increased risk, underscoring the importance of modifiable lifestyle factors. In contrast, other demographic and comorbidity variables showed no significant association.

These results underscore the central role of blood pressure control in mitigating early kidney damage among genetically and environmentally predisposed individuals. The observation that participants with no identifiable CKD risk factors were significantly less likely to exhibit proteinuria reinforces the concept of risk clustering, where multiple comorbidities amplify renal vulnerability.

From a clinical perspective, these findings advocate for family-centered screening programs that incorporate simple urine testing and blood pressure monitoring for relatives of dialysis patients. The use of UACR testing proved both feasible and informative in detecting subclinical kidney injury in asymptomatic individuals. Such early identification allows for proactive counseling, lifestyle modification, and medical intervention, all of which can delay CKD progression.

From a public health standpoint, implementing family-based preventive programs can significantly reduce the long-term burden of CKD and dialysis dependency. Integrating screening into community clinics and primary care settings could improve early diagnosis, especially in low-resource contexts. Efforts should focus on weight management, hypertension control, and health education targeting families affected by CKD.

Future research should extend this work through longitudinal studies to monitor renal outcomes among high-risk relatives, exploring genetic, dietary, and environmental determinants of susceptibility. This approach could inform tailored prevention policies, ultimately contributing to global efforts to reduce CKD morbidity and mortality.

In conclusion, the study provides compelling evidence that hypertension and elevated body weight are key, modifiable predictors of proteinuria among relatives of CKD patients. Strengthening family-based screening initiatives and prioritizing lifestyle and blood pressure control are practical, evidence-driven strategies to mitigate CKD progression in at-risk Filipino families and beyond.