期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 11, 期 21, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.122.026685
关键词
all-cause mortality; cardiovascular disease; CKD risk categories; KDIGO; progression; transition; young adults
资金
- National Heart, Lung, and Blood Institute
- University of Alabama at Birmingham [HHSN268201800005I, HHSN268201800007I]
- Northwestern University [HHSN268201800003I]
- University of Minnesota [HHSN268201800006I]
- Kaiser Foundation Research Institute [HHSN268201800004I]
This study found that progression to higher CKD risk categories was common among young to middle-aged adults, and it was associated with cardiovascular disease and mortality.
Background Previous studies of worsening chronic kidney disease (CKD) based on declining estimated glomerular filtration rate (eGFR) or increasing urine albumin-creatinine ratio (UACR) are limited to later middle-age and older adults. We examined associations of CKD progression and incident cardiovascular disease (CVD) and mortality in younger adults. Methods and Results We studied 4382 adults in CARDIA (Coronary Artery Risk Development in Young Adults) initially aged 27 to 41 years and prospectively over 20 years. Five-year transition probabilities across CKD risk categories were based on eGFR and UACR measured at each exam. Proportional hazards models predicted incident CVD and all-cause mortality by time-varying CKD risk category, adjusting for demographics and CVD risk factors. Progression of CKD risk categories over 20 years occurred in 28.7% (1256/4382) of participants, driven by increases in UACR, but including 5.8% (n=255) with eGFR<60 mL/min per 1.73 m(2) or UACR >= 300 mg/g. Compared with eGFR >= 60 and UACR <10, demographic and smoking-adjusted hazard ratios for CVD were 1.62 (95% CI, 1.21-2.18) for low CKD risk (eGFR >= 60 with UACR 10-29) and 13.65 (95% CI, 7.52-24.79) for very high CKD risk (eGFR <30 or eGFR 30-44 with UACR 30-299; or eGFR 30-59 with UACR >= 300). Corresponding hazard ratios for all-cause mortality were 1.42 (95% CI, 1.08-1.88) and 14.75 (95% CI, 9.97-21.82). Although CVD associations were attenuated after adjustment for mediating CVD risk factors, all-cause mortality associations remained statistically significant. Conclusions Among young to middle-aged adults, progression to higher CKD risk category was common. Routine monitoring eGFR and UACR holds promise for prevention of CVD and total mortality.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据