Risk factors for chronic kidney disease are present decades before diagnosis

Mid-Adulthood Risk Factor Profiles for CKD
Gearoid M. McMahon*†, Sarah R. Preis‡, Shih-Jen Hwang* and Caroline S. Fox*†§
+ Author Affiliations

*National Heart, Lung, and Blood Institute’s Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts;
†Renal Division and
§Division of Endocrinology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and
‡Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
Correspondence:
Dr. Caroline S. Fox, National Heart, Lung, and Blood Institute’s Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702. Email: foxca@nhlbi.nih.gov
Received for publication July 18, 2013.
Accepted for publication March 17, 2014.
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 m2) 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 HDLc (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.

http://jasn.asnjournals.org/content/early/2014/06/25/ASN.2013070750