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Grip strength modifies the association between estimated glomerular filtration rate and all-cause mortality
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics.ORCID iD: 0000-0001-8128-732x
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics.
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-3649-2639
Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.ORCID iD: 0000-0001-6328-5494
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-75760OAI: oai:DiVA.org:oru-75760DiVA, id: diva2:1342372
Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved
In thesis
1. A life-course approach to chronic kidney disease: risks and consequences
Open this publication in new window or tab >>A life-course approach to chronic kidney disease: risks and consequences
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 89
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 196
Keywords
chronic kidney disease, pneumonia, grip strength, creatinine, cystatin C, adolescence, life-course epidemiology, risk factor, mortality
National Category
General Practice Urology and Nephrology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-74659 (URN)978-91-7529-290-8 (ISBN)
Public defence
2019-09-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-08-13Bibliographically approved

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Sundin, Per-OlaUdumyan, RuzanFall, KatjaMontgomery, Scott

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