Researchers Identify More Risk Factors for Chronic Kidney Disease Progression

Amanda H. Anderson, PhD, MPH

A better understanding of novel chronic kidney disease (CKD) progression risk factors could help improve the identification of high-risk subgroups and inform mechanistic investigators.

A team, led by Amanda H. Anderson, PhD, MPH, Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, characterized chronic kidney disease progression across different levels of several risk factors and identified independent risk factors for disease progression among those with and without diabetes.

The Chronic Renal Insufficiency Cohort (CRIC) study took place at 7 US clinical centers involved 3379 adult patients with chronic kidney disease. Each patient had up to 12.3 years of follow-up and 47% of the patient population had diabetes.

The researchers identified 30 risk factors for chronic kidney disease progression across sociodemographic, behavioral, clinical, and biochemical domains at baseline.

The investigators sought main outcomes of the estimated glomerular filtration rate (eGFR) slope and the composite of halving of eGFR or initiation of kidney replacement therapy.

They also performed stepwise selections of independent risk factors that were stratified by diabetes status using linear mixed effects and Cox proportional hazards models.

For patients without and with diabetes the mean eGFR was -1.4 and -2.7 mL/min/1.73m²/year, respectively.

Among the patients with diabetes, the multivariable-adjusted hazard of the composite outcome was approximately two-fold or greater with higher levels of the inflammatory chemokine CXCL 12, the cardiac marker N-terminal pro-B-type natriuretic peptide (NTproBNP) and the kidney injury marker urine neutrophil gelatinase-associated lipocalin (NGAL).

For patients without diabetes, low serum bicarbonate and higher high sensitivity troponin T, NTproBNP, and urine NGAL were all significantly associated with a 1.5-fold or greater rate of the composite outcome.

“Strong associations for cardiac markers, plasma CXCL12 and urine NGAL exceeded that of systolic blood pressure ≥140 mmHg, a well-established risk factor for CKD progression,” the authors wrote. “This warrants further investigation into the potential mechanisms these markers indicate and opportunities to use them to improve risk stratification.”

Recently, researchers from Johns Hopkins School of Medicine, examined national trends in racial and ethnic disparities in receipt of predialysis nephrology care at least 1 year prior to dialysis initiation in the US from 2005-2015.

In 2005-2007, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults, when compared with White adults.

On the other hand, in 2015-2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults, when compared with White adults.

The study, “Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study,” was published online in the American Journal of Kidney Diseases.