Long-term predictive models of risk factors for early chronic kidney disease: a longitudinal study

// Wen-Chih Wu 1, 2 , Po-Chien Hsieh 1 , Fu-Kang Hu 3 , Jen-Chun Kuan 4, 5 , Chi-Ming Chu 1 , Chien-An Sun 6, 7 , Tsan Yang 8 , Sui-Lung Su 1 and Yu-Ching Chou 1 1 School of Public Health, National Defense Medical Center, Taipei, Taiwan 2 Department of Surgery, Suao and Yuanshan branches of Taipei Veterans General Hospital, Yilan, Taiwan 3 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan 4 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan 5 Department of Biostatistics, Firma Clinical Research, Hunt Valley, MD, USA 6 Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan 7 Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan 8 Department of Health Business Administration, Meiho University, Pingtung, Taiwan Correspondence to: Yu-Ching Chou, email: trishow@mail.ndmctsgh.edu.tw Keywords: predictor; chronic kidney disease (CKD); aircrew; early detection; longitudinal study Received: August 02, 2017      Accepted: February 27, 2018      Published: April 13, 2018 ABSTRACT Background: The high incidence and prevalence of chronic kidney disease (CKD) in Taiwan have produced tremendous burdens on health care resources. The work environment of air force special operations personnel engenders high psychological stress, and the resulting increased blood pressure can lead to glomerular hypertension and accelerated glomerular injury in the long term. The aim of the study was to establish the predictive models to define the predictors of CKD. Results: The results indicated that the prevalence of CKD over 4 consecutive years was 3.8%, 9.4%, 9.0%, and 9.4%. The capability of using occult blood in urine to predict the risk of CKD after 1, 2, and 3 years was statistically significant. The age-adjusted odds ratio (OR) and 95% confidence interval (CI) were 7.94 (95% CI: 2.61–24.14), 12.35 (95% CI: 4.02–37.94) and 4.25 (95% CI: 1.32–13.70), respectively. Discussion: The predictive power of occult blood in urine for the risk of CKD in each model was statistically significant. Future investigations can explore the feasibility of implementing simple and accurate urine dipsticks for preliminary testing besides annual aircrew physical examinations to facilitate early detection and treatment. Methods: This study was a longitudinal study, in which air force special operations personnel who received physical examinations at military hospitals between 2004 and 2010 were selected. CKD was determined based on the definition provided by the US National Kidney Foundation. Overall, 212 participants that could be followed continuously for 4 years were analyzed.