CLINICAL AND NON-CLINICAL RISK FACTORS FOR INCIDENT CHRONIC KIDNEY DISEASE (CKD): ANALYSIS OF US NATIONWIDE PRE-CKD VETERAN POPULATION

 

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https://storage.unitedwebnetwork.com/files/1099/948a4a9a942878e270f575b08969538c.pdf
CLINICAL AND NON-CLINICAL RISK FACTORS FOR INCIDENT CHRONIC KIDNEY DISEASE (CKD): ANALYSIS OF US NATIONWIDE PRE-CKD VETERAN POPULATION

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Guofen
Yan
Guofen Yan guofen.yan@virginia.edu University of Virginia Public Health Sciences Charlottesville United States *
Julia Scialla js7rk@uvahealth.org University of Virginia Medicine Charlottesville United States -
Wei Yu wei.yu@virginia.edu University of Virginia Public Health Sciences Charlottesville United States -
Fei Heng f.heng@unf.edu University of North Florida Mathematics & Statistics Jacksonville United States -
Robert Nee robertnee8@gmail.com Walter Reed National Military Medical Center Medicine Bethesda United States -
Tom Greene tom.greene@hsc.utah.edu University of Utah Population Health Sciences Salt Lake City United States -
Monique Cho monique.cho@hsc.utah.edu University of Utah Medicine Salt Lake City United States -
Alfred Cheung alfred.cheung@hsc.utah.edu University of Utah Medicine Salt Lake City United States -
Keith Norris kcnorris@mednet.ucla.edu UCLA Medicine Los Angeles United States -
 
 
 
 
 
 

Chronic kidney disease (CKD) is rising as a global public health threat, with increasing prevalence worldwide. In the US, CKD is more prevalent among women, racial and ethnic minority populations, and older adults, but studies of incident CKD are less common. Using a real-world US population with regular health care utilization, we examined a broad range of clinical and non-clinical risk factors for incident CKD and assessed potential differences in these risk factors by age, sex, and race/ethnicity.

The cohort included 1,446,101 US veterans aged 18-85 years who had their first (index date) recorded estimated glomerular filtration rate (eGFR) between 60 and 100 mL/min/1.73m2 (based on the 2021 CKD-EPI equation) during 2003-2013 in the Veterans Health Administration (VHA). Participants were followed through May 2018 for incident CKD, defined as either subsequent eGFR values decreased to <60 mL/min/1.73m2 for >3 months or urine albumin-to-creatinine ratio (UACR) values ≥30 mg/g for >3 months, whichever occurred first. Veterans with a prior eGFR <60 mL/min/1.73m2 or UACR ≥30 mg/g, or with <2 years of VHA enrollment before the index date were excluded. Death-censored multivariable Cox regression models were used to examine demographic, socioeconomic, lifestyle, and clinical risk factors for incident CKD.

At baseline, the mean age was 56 years and mean eGFR was 87 mL/min/1.73m2. Over 5-15 years of follow-up, 11% developed CKD. Multivariable Cox regression identified several important risk factors (Table). The risk of incident CKD increased by 18% for every 5-year increase in age and by 29% for men versus women. Compared with White participants, the CKD risk was higher among all other racial and ethnic groups: 17% higher for Asian, Native Hawaiian/Pacific Islander, 34% higher for Black, and 13% for both Hispanic and American Indian/Alaska Native groups. Higher CKD risk was also associated with unemployment (23% higher vs. employed), being divorced, separated or widowed (12% higher vs. married), and current or former smoking (29% and 9% higher vs. never smoking). For clinical factors, diabetes was associated with the greatest increase in CKD risk (148% higher), followed by HIV/AIDS (54%) despite the small number with HIV, obesity (33%), hypertension (27%), heart failure (26%), and liver disease (20%). These associations were largely consistent across sex, age (<65 or ≥65 years), and racial and ethnic groups, except that marital status was not associated with CKD risk among women.

Table.  The risk factors identified by multivariable Cox regression models, adjusting for year of incident chronic kidney disease
DomainRisk factorHazard ratio (95% confidence interval)
DemographicsAge (5-year increase)1.18 (1.17-1.18)
Sex (male vs. female)1.29 (1.25-1.32)
Asian, Native Hawaiian/Pacific Islander (vs. White)1.17 (1.12-1.22)
Black (vs. White)1.34 (1.32-1.36)
Hispanic (vs. White)1.13 (1.10-1.15)
American Indian/Alaska Native (vs. White)1.13 (1.06-1.20)
Multiple or other races (vs. White)1.07 (1.03-1.11)
Socioeconomic & lifestyle factorsEmployment
     Unemployed (vs. employed)1.23 (1.21-1.25)
     Retired (vs. employed)1.13 (1.12-1.15)
Marital status
     Divorced, separated, or widowed (vs. married or partner)
1.12 (1.11-1.14)
     Never married (vs. married or partner)1.06 (1.04-1.08)
Smoking
     Current smoking (vs. never smoking)1.29 (1.27-1.31)
     Former smoking (vs. never smoking)1.09 (1.07-1.10)
Clinical factorseGFR (5 mL/min/1.73m2 decrease)1.28 (1.28-1.29)
Diabetes2.48 (2.46-2.51)
HIV/AIDS1.54 (1.45-1.64)
Obesity (body mass index ≥30 vs. <30)1.33 (1.32-1.34)
Hypertension1.27 (1.25-1.28)
Heart failure1.26 (1.24-1.29)
Liver disease1.20 (1.16-1.24)
Peripheral vascular disease1.08 (1.06-1.09)
Coronary artery disease1.07 (1.06-1.09)

Older age, male sex, and racial/ethnic groups other than White race group were associated with higher risks of incident CKD. In addition to traditional clinical risk factors, socioeconomic and lifestyle factors appear to play an important role in CKD development.

Kewords