oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Predictors in Adolescence of ESRD in Middle-Aged Men
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Örebro University Hospital, Örebro, Sweden .
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. (Clinical Epidemiology and Biostatistics)
School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom . (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
2014 (English)In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 64, no 5, p. 723-729Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Saunders Elsevier, 2014. Vol. 64, no 5, p. 723-729
Keywords [en]
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
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:oru:diva-39453DOI: 10.1053/j.ajkd.2014.06.019ISI: 000344237900012PubMedID: 25124945Scopus ID: 2-s2.0-84908479380OAI: oai:DiVA.org:oru-39453DiVA, id: diva2:770383
Note

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

Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2019-09-19Bibliographically 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: 2019-09-19Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Sundin, Per-OlaUdumyan, RuzanMontgomery, Scott

Search in DiVA

By author/editor
Sundin, Per-OlaUdumyan, RuzanMontgomery, Scott
By organisation
School of Health and Medical Sciences, Örebro University, Sweden
In the same journal
American Journal of Kidney Diseases
Urology and Nephrology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 433 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf