Risk Factors of Chronic Kidney Disease Incidence: A Retrospective Cohort Study in Abu Dhabi

Abstract

Background: Chronic kidney disease (CKD) is a growing global health concern, particularly in populations with a high prevalence of cardiovascular risk factors, such as the United Arab Emirates (UAE). Objective: To quantify the burden of CKD among UAE nationals and identify the risk factors that contribute to its development and progression. Methods: This is a retrospective cohort study. In 2023, data was collected from a cohort of 8699 subjects who participated in thenational cardiovascular screening from 2011 to 2013. The follow-up period was an average of 9.2 years. Data was collected from electronic medical records of Emirati adults attending Abu Dhabi primary health centers. Results: At baseline, the study included 8671 participants, with a total CKD prevalence in 2023 of 8%, 6% among females and 10.1% among males. The incidence of CKD over the years of follow up was 7.3%, 5.5% among females and 9.2% among males. Using Cox regression, significant predictors assessed at screening were age, smoking, higher levels of HBA1C, coronary heart disease diagnosis at baseline, hypertension, higher mean blood pressure value, low eGFR, higher levels of vitamin D and eGFR >120 mL/min/1.73m2. The derived predictive model from Cox regression had c-statistics of 0.829, which was better than eGFR alone, which had a c-statistics of 0.803, by 0.026. From bassline subjects’ characteristics, significant associations with greater eGFR decline over the follow-up period were older age higher at baseline, being treated for hypertension, and higher levels of eGFR, HDL, SBP, and HBA1C. Significant associations of baseline characteristics with abnormal Albumin-Creatinine Ratio (ACR) were older age higher at baseline, higher levels of mean blood pressure, lower HDL levels, female sex, and higher eGFR. Having a diagnosis of ASCVD was protective from developing abnormal ACR. Additionally, logistic regression showed significant comorbidities with new onset CKD during the follow-up period, which were older age at screening, acute coronary syndrome, hypertension, metabolic fatty liver disease, and continuing smoking since baseline. In regard to hyperfiltration, defined as eGFR >120 ml/min/1.73m2, its prevalence was 33.5% (28.1% of males and 39.2% of females) at baseline. Significant associations with hyperfiltration were female sex, younger age group, obesity, current smoking, lower systolic blood pressure values, lower cholesterol and vitamin D levels, and higher HDL and HbA1c levels. Conclusion: These findings alert for targeted preventive strategies and comprehensive healthcare interventions to address CKD and its complications in Abu Dhabi. Derived prediction models provide opportunities for targeting these risk factors in clinical practice and stimulate further research opportunities to predict CKD progression.