To Örebro University

oru.seÖrebro universitets publikasjoner
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
A life-course approach to chronic kidney disease: risks and consequences
Örebro universitet, Institutionen för medicinska vetenskaper.ORCID-id: 0000-0001-8128-732x
2019 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Successful primary prevention of chronic kidney disease (CKD) relies on understanding the pathways leading to established disease, including how they extend over the life-course. Projects in this thesis examine risk factors for CKD and consequences of impaired kidney function from a life-course perspective using routinely collected health-data in Swedish registers and research cohort data from the United Kingdom.

The main findings regarding risk factors for CKD are, that markers of health and development determined at conscription assessment in adolescence, independently predict diagnosis of end-stage renal disease in middle age. We also identified a persistent increased risk of CKD following hospital admission with pneumonia in adulthood with highest magnitude risks in years immediately following infection, but still statistically significantly raised more than 15 years after the pneumonia episode. Our main findings relevant to predicting the consequences of impaired kidney function are that creatinine and cystatin C used clinically to estimate kidney function (estimated glomerular filtration rate, eGFR) have associations with increased mortality risk independent of GFR measured with an exogenous filtration marker (mGFR). If cystatin C and creatinine are combined, adding mGFR does not improve mortality risk prediction. Another important finding is that moderately reduced eGFR is only associated with a statistically significant increased mortality risk among individuals in the lowest third of the distribution of grip strength in a general population sample followed for 4-5 years, after adjustment for potential confounding factors.

These results highlight the importance of adopting a life-course perspective when studying risk factors for CKD, since these associations can extend over different stages in the life-course. When assessing increased mortality risk associated with measures of GFR, combining cystatin and creatinine improves risk prediction. Potential effect modification across subgroups, including by grip strength, should be considered.

sted, utgiver, år, opplag, sider
Örebro: Örebro University , 2019. , s. 89
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 196
Emneord [en]
Chronic kidney disease, pneumonia, grip strength, creatinine, cystatin C, adolescence, life-course epidemiology, risk factor, mortality
HSV kategori
Identifikatorer
URN: urn:nbn:se:oru:diva-74659ISBN: 978-91-7529-290-8 (tryckt)OAI: oai:DiVA.org:oru-74659DiVA, id: diva2:1322949
Disputas
2019-09-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2019-06-11 Laget: 2019-06-11 Sist oppdatert: 2024-03-06bibliografisk kontrollert
Delarbeid
1. Predictors in Adolescence of ESRD in Middle-Aged Men
Åpne denne publikasjonen i ny fane eller vindu >>Predictors in Adolescence of ESRD in Middle-Aged Men
2014 (engelsk)Inngår i: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 64, nr 5, s. 723-729Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Identification of predictors of end-stage renal disease (ESRD) in adolescence could provide intervention targets and improve understanding of the cause.

Study Design: Register-based nested case-control study.

Setting & Participants: A cohort of all Swedish male residents born from 1952 through 1956 who attended mandatory military conscription examinations in late adolescence was used to identify 534 cases and 5,127 controls matched by birth year, county, and vital status.

Predictor: Erythrocyte sedimentation rate (ESR), proteinuria, blood pressure, and body mass index (BMI) in late adolescence.

Outcomes: ESRD (defined here as dialysis therapy, kidney transplantation, surgical procedures creating long-term access for dialysis therapy, or chronic kidney disease stage 5) from 1985 through 2009.

Measurements: Physical working capacity and cognitive function score in late adolescence. Head of household's occupation and household crowding measured as person-per-room ratio from the 1960 census when participants were children.

Results: Proteinuria is associated notably with future ESRD, with an adjusted OR of 7.72 (95% CI, 3.94-15.14; P < 0.001) for trace or positive dipstick findings. ESR has a dose-dependent association with ESRD with an adjusted OR of 2.07 (95% CI, 1.14-3.75; P = 0.02) for ESR > 15 mm/h. Hypertension is associated strongly with future ESRD with an OR of 3.97 (95% CI, 2.08-7.59; P < 0.001) for grade 2 hypertension and higher. Elevated BMI is associated statistically significantly with increased ESRD risk with an OR of 3.53 (95% CI, 2.04-6.11; P < 0.001) for BMI >= 30 compared with 18.5-<25kg/m(2).

Limitations: The study was limited to men, with no initial estimation of glomerular filtration rate, and information on smoking was unavailable.

Conclusions: ESR, proteinuria, BMI, and blood pressure in late adolescence are independent predictors of ESRD in middle-aged men. This highlights the long natural history and importance of adopting a life-course approach when considering the cause of chronic kidney disease. (C) 2014 by the National Kidney Foundation, Inc.

sted, utgiver, år, opplag, sider
Saunders Elsevier, 2014
Emneord
End-stage renal disease (ESRD), erythrocyte sedimentation rate (ESR), proteinuria, body mass index (BMI), hypertension, adolescence, inflammation, disease trajectory, risk factor, etiology, kidney disease progression
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-39453 (URN)10.1053/j.ajkd.2014.06.019 (DOI)000344237900012 ()25124945 (PubMedID)2-s2.0-84908479380 (Scopus ID)
Merknad

Funding Agencies:

UK Economic and Social Research Council RES-596-28-0001  ES/J019119/1

Research Committee of Orebro County Council OLL-213581  OLL-333371

Tilgjengelig fra: 2014-12-10 Laget: 2014-12-10 Sist oppdatert: 2024-03-06bibliografisk kontrollert
2. Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine
Åpne denne publikasjonen i ny fane eller vindu >>Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine
Vise andre…
2017 (engelsk)Inngår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 32, nr 4, s. 663-670Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Cystatin C may add explanatory power for associations with mortality in combination with other filtration markers, possibly indicating pathways other than glomerular filtration rate (GFR). However, this has not been firmly established since interpretation of associations independent of measured GFR (mGFR) is limited by potential multicollinearity between markers of GFR. The primary aim of this study was to assess associations between cystatin C and mortality, independent of mGFR. A secondary aim was to evaluate the utility of combining cystatin C and creatinine to predict mortality risk.

Methods: Cox regression was used to assess the associations of cystatin C and creatinine with mortality in 1157 individuals referred for assessment of plasma clearance of iohexol.

Results: Since cystatin C and creatinine are inversely related to mGFR, cystatin C - 1 and creatinine - 1 were used. After adjustment for mGFR, lower cystatin C - 1 (higher cystatin C concentration) and higher creatinine - 1 (lower creatinine concentration) were independently associated with increased mortality. When nested models were compared, avoiding the potential influence of multicollinearity, the independence of the associations was supported. Among models combining the markers of GFR, adjusted for demographic factors and comorbidity, cystatin C - 1 and creatinine - 1 combined explained the largest proportion of variance in associations with mortality risk ( R 2  = 0.61). Addition of mGFR did not improve the model.

Conclusions: Our results suggest that both creatinine and cystatin C have independent associations with mortality not explained entirely by mGFR and that mGFR does not offer a more precise mortality risk assessment than these endogenous filtration markers combined.

sted, utgiver, år, opplag, sider
Oxford University Press, 2017
Emneord
GFR, creatinine, cystatin C, epidemiology, prognosis
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-57361 (URN)10.1093/ndt/gfx004 (DOI)000401057000013 ()28340079 (PubMedID)2-s2.0-85019091905 (Scopus ID)
Merknad

Funding agencies:

Research Committee of the Örebro County Council (OLL-330601, OLL-408481 and OLL-506561)

Tilgjengelig fra: 2017-05-21 Laget: 2017-05-21 Sist oppdatert: 2024-03-06bibliografisk kontrollert
3. Hospital admission with pneumonia and subsequent persistent risk of chronic kidney disease: national cohort study
Åpne denne publikasjonen i ny fane eller vindu >>Hospital admission with pneumonia and subsequent persistent risk of chronic kidney disease: national cohort study
2018 (engelsk)Inngår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 971-979Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD).

Patients and methods: Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into <= 5, > 5-<= 15, and > 15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31, 2009, whichever occurred first.

Results: During a median follow-up of 36.7 (interquartile range 35.3-37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41-20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91-6.93) and then attenuated with increasing time.

Conclusion: Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions.

sted, utgiver, år, opplag, sider
DOVE Medical Press Ltd., 2018
Emneord
Pneumonia, kidney disease, end-stage renal disease, inflammation, cohort study
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-68653 (URN)10.2147/CLEP.S169039 (DOI)000441779100001 ()30147376 (PubMedID)2-s2.0-85057756705 (Scopus ID)
Merknad

Funding Agency:

UK Economic and Social Research Council  RES-596-28-0001  ES/JO19119/1

Tilgjengelig fra: 2018-08-31 Laget: 2018-08-31 Sist oppdatert: 2024-03-06bibliografisk kontrollert
4. Grip strength modifies the association between estimated glomerular filtration rate and all-cause mortality
Åpne denne publikasjonen i ny fane eller vindu >>Grip strength modifies the association between estimated glomerular filtration rate and all-cause mortality
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-75760 (URN)
Tilgjengelig fra: 2019-08-13 Laget: 2019-08-13 Sist oppdatert: 2019-08-13bibliografisk kontrollert

Open Access i DiVA

Cover(130 kB)62 nedlastinger
Filinformasjon
Fil COVER01.pdfFilstørrelse 130 kBChecksum SHA-512
642408188c77ec4acb2634f9382260efc77936097c9db6e092aa6b6f5b169c6554223be240db3061c3cc9d1aff95a78eb2eb2e2582083b160fb44f9e595d9750
Type coverMimetype application/pdf
A life-course approach to chronic kidney disease: risks and consequences(1288 kB)812 nedlastinger
Filinformasjon
Fil FULLTEXT01.pdfFilstørrelse 1288 kBChecksum SHA-512
afbd7f5a17330ea9088caf78b3f314ae77d3b50ff3a800d73d3092e523c6c68a7181d2284c6f88f55c9731ba23455d603ca834c7a5618ddfe32dc8175ca4a4fc
Type fulltextMimetype application/pdf
Spikblad(88 kB)63 nedlastinger
Filinformasjon
Fil SPIKBLAD01.pdfFilstørrelse 88 kBChecksum SHA-512
a27e8b088ff1e1f975b290f5a9fee5f852b7ed74f6f4c409d38b11cf406250ac2db1a1577b9ef4c8744c9a40465a449138f2c829329330990c18e203c541e50a
Type spikbladMimetype application/pdf

Person

Sundin, Per-Ola

Søk i DiVA

Av forfatter/redaktør
Sundin, Per-Ola
Av organisasjonen

Søk utenfor DiVA

GoogleGoogle Scholar
Totalt: 812 nedlastinger
Antall nedlastinger er summen av alle nedlastinger av alle fulltekster. Det kan for eksempel være tidligere versjoner som er ikke lenger tilgjengelige

isbn
urn-nbn

Altmetric

isbn
urn-nbn
Totalt: 944 treff
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf