Mid-Adulthood Risk Factor Profiles for CKD

Abstract

Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present $30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR#60 ml/min per 1.73 m 2 ) at examination cycles 6, 7, and 8 were age-and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDL c (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable $30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.

Cardiometabolic Risk Factors Associated with Renal Function in Apparently Healthy Young Students: A Cross-Sectional Study

“…The present study shows that 76% of our study population comprising 1 st year university students had at least one CMRF associated with a future CKD risk. This young population is considered healthy, and due to this misconception, they are not either screened for any risk factor or are any interventions implemented in them to modify risk factors 9,16 . Obesity, when combined with other CMRF 9,17,18 , can lead to progressive decrease in GFR.…”

“…Unfortunately, young adults are not systematically screened for these risk factors, as they are presumed to be healthy. This is an alarming fact if we consider that in Mexico, 14.3% of the population is between 18 and 25 years old 9 .…”

The Tubulointerstitial Pathophysiology of Progressive Kidney Disease

“…Potentially modifiable risk factors include obesity, hypertension, acidosis, proteinuria, anemia, vascular dysfunction and cigarette smoking. Obesity 17 may contribute to progression by increasing per-nephron load, as is the case for the non-modifiable risk factors listed above, or it may reflect metabolic factors that affect kidney function. Hypertension 18,19 remains a complex issue.…”

Kidney Disease in Obesity and Metabolic Syndrome

“…In longitudinal studies with longer-term follow-up, MetS has been associated with progression of chronic kidney disease and development of proteinuria (Lora et al 2009). Conversely, a retrospective study has recently shown that those with CKD were more likely to have all five of the MetS criteria as far back as 20-30 years prior to the CKD diagnosis (McMahon et al 2014). When addressed individually in meta-analyses, each criterion of the MetS contributes independently to the development of CKD, suggesting that dyslipidemia (elevated triglycerides and low HDL levels) may also be an important modifiable risk factor for the prevention of CKD in addition to diabetes, hypertension, and obesity (Thomas et al 2011).…”