ADVERSE CHILDHOOD EXPERIENCES AND URINARY PROTEIN CREATININE RATIO IN A COHORT OF UNSELECTED MEXICAN PARTICIPANTS

Introduction:

Adverse Childhood Experiences (ACEs) are a set of critical stressors that occur before the age of 18. They comprise severe events in the early years of life of a person such as verbal, physical or sexual abuse as well as challenging family experiences (Ozieh, 2020). Approximately 1 billion of individuals from 0 to 17 years around the world (50% of all children) are exposed to ACEs each year. Moreover, the estimated prevalence of ACEs is 44% and 59% in high vs low and middle-income countries. ACEs have consistently emerged as strong health determinants on the adult life of affected individuals (Bussières, 2023). While the relationship between ACEs and cardiovascular morbidity is well established, there is scant evidence on the role ACEs play in kidney health. Previous research has focused on determining kidney function through GFR. However, to the best of our knowledge, no study has focused on relating ACEs to dipstick parameters, which are readily available and easy to implement in screening campaigns.

Methods:

We analyzed data from the first phase of FRENALA, an observational study aiming to clarify the determinants of kidney health in the Mexican population. Appropriate authorization was obtained from our Institutional Ethics and Research Committee. We employed a multiple regression model to evaluate the contribution of age, sex, BMI, SSQ score (a validated dietary sodium consumption scale), alcohol use, cardiovascular disease, smoking pack-years, hypertension and ACEs to Urinary Protein Creatinine Ratio (UPCR). Statistical analyses and graphics were performed using STATA (v. 18.0; STATA Corp, College Station, TX, USA).

Results:

The sample consisted of 151 participants of FRENALA. Age (β = -0.0021, p = 0.021), sex (β = -0.0955, p = 0.001), BMI (β = 0.0048, p = 0.009), alcohol use (β = -0.0950, p = 0.002), cardiovascular disease (β = 0.1281, p = 0.028), hypertension (β = 0.0684, p = 0.030) and ACEs (β = 0.0173, p = 0.005) emerged as statistically significant predictors of UPCR (Figure 1). The overall model resulted statistically significant (p<0.0001) with an adjusted R2 of 0.25 (Table 1).

Conclusions:

BMI, presence of cardiovascular, hypertension and ACEs arose as positive predictors of UPCR. Interestingly, greater age, male sex and alcohol use correlated with lesser levels of UPCR. We believe this apparently contradictory finding was due to our relatively small sample size. Regarding ACEs, we confirmed their potential role in determining kidney health as represented by UPCR. These findings open the door to future screening programs that take into consideration classical dipstick parameters as well as psychological ones. More research should be conducted to appropriately ascertain the effect of ACEs on kidney function tests such as GFR.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.