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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 21, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This manuscript has been reviewed by CARDIA for scientific content. The sponsor, NHLBI has a representative on the Steering Committee of CARDIA and participated in study design, data collection, and scientific review of this paper. The sponsor had no role in data analysis, data interpretation, or writing of this report. The data used in this study are available from the CARDIA Coordinating Center (www.cardia.dopm.uab.edu) on reasonable request.
Conflicts of Interest: HJK has served as a consultant for Bayer pharmaceuticals and CSL Vifor and was a past president of the National Kidney Foundation. ARC has served as a consultant for Novartis, Reata, Amgen, and Relypsa. YC, DRJ, GRS, and DAD declare none.
Authorship: All authors had access to the data and a role in writing this manuscript.
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