“Nontraditional Risk Factors for Progression Through Chronic Kidney Disease Risk Categories: The Coronary Artery Risk Development in Young Adults Study” was originally published in the April 2023 issue of The American Journal of Medicine.
Abstract
Background
There may be nontraditional pathways of chronic kidney disease (CKD) progression that are complementary to classical pathways. Therefore, we aimed to examine nontraditional risk factors for incident CKD and its progression.
Methods
We used the generally healthy population (n = 4382) starting at age 27-41 years in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, which is an observational longitudinal study. Nontraditional risk factors included forced vital capacity, inflammation, serum urate, and serum carotenoids. CKD risk category was classified using the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) measured in 1995-1996 and repeated every 5 years for 20 years: No CKD, low risk, moderate risk, high risk, and very high risk.
Results
At baseline, 84.8% had no CKD (eGFR ≥60 mL/min/1.73 m2 and UACR <10 mg/g), 10.3% were in the low risk (eGFR ≥60 and UACR 10-29), and 4.9% had CKD (eGFR <60 and/or UACR ≥ 30). Nontraditional risk factors were significantly associated with the progression of CKD to higher categories. Hazard ratios per standard deviation of the predictor for incident CKD and its progression from the No CKD and low and moderate risk into CKD were inverse for forced vital capacity and serum carotenoids and positive for serum urate, GlycA, and C-reactive protein, the first 3 even after adjustment for conventional risk factors.
Conclusion
Several nontraditional markers were significantly associated with an increased risk of progression to higher CKD categories in generally healthy young to middle-aged adults.
Clinical Significance
- About 29% of the Black and white participants progressed to a higher chronic kidney disease risk category. Beyond hypertension, diabetes, triglycerides, and obesity, forced vital capacity, serum inflammatory markers, urate, and carotenoids were strongly associated with chronic kidney disease progression.
- Transition into early stages of chronic kidney disease is common over 20 years starting in early middle age. The existence of several risk markers enables timely beginning of prevention and treatment activities.
— Yuni Choi, PhD, David R. Jacobs Jr, PhD, Holly J. Kramer, MD, MPH, Gautam R. Shroff, MBBS, Alexander R. Chang, MD, MS, Daniel A. Duprez, MD, PhD
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