Key result
Progression to very high CKD risk in young adults linked to ~14-fold higher CVD risk.
Why the study?
Previous studies of worsening CKD based on declining eGFR or increasing UACR were limited to later middle-age and older adults.
Does progression to higher CKD risk categories increase the risk of incident cardiovascular disease and all-cause mortality in young to middle-aged adults?
Cohort (n=4,382)
Does progression to higher CKD risk categories increase the risk of incident cardiovascular disease and all-cause mortality in young to middle-aged adults?
Progression to higher CKD risk categories in young to middle-aged adults is common and strongly associated with increased risks of incident cardiovascular disease and all-cause mortality.
Progression to very high CKD risk may flag young adults for intensified monitoring; leaves open whether targeting progression improves outcomes.
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.
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Choi et al. (2022) conducted a cohort in Chronic kidney disease (n=4,382). Very high CKD risk vs. eGFR ≥60 and UACR <10 was evaluated on Incident cardiovascular disease (CVD) (HR 13.65, 95% CI 7.52-24.79). Progression to very high CKD risk in young adults was strongly associated with incident cardiovascular disease (HR 13.65; 95% CI 7.52-24.79) and all-cause mortality (HR 14.75; 95% CI 9.97-21.82).
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