Gearoid M McMahon1,2, Shih-Jen Hwang1, Caroline S Fox1,3. 1. National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA. 2. Division of Nephrology, Brigham and Women's Hospital, Boston, MA, USA. 3. Division of Endocrinology, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: An accurate estimation of the lifetime risk of chronic kidney disease (CKD) can aid in patient education while also informing the development of public health screening programs and educational campaigns. METHODS: Framingham Offspring Study participants were included if they were free of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) at age 50 years and had at least two serum creatinine measures during follow-up (mean 16 years, 49 506 person-years). We estimated the lifetime risk of CKD to age 90 years adjusting for the competing risk of death in the overall cohort and in population subgroups with known CKD risk factors including hypertension, obesity and diabetes. RESULTS: Overall 3362 individuals (52% women) were included in the study. Mean age at study baseline was 54 years. By the end of the study, 729 individuals (21.7%) developed CKD and 618 (18.4%) died. At age 50 years, the cumulative lifetime risk of CKD was 41.3% [95% confidence interval (CI) 38.5-44.0]. The risk was increased in those with risk factors at baseline including diabetes (52.6%, 95% CI 44.8-60.4), hypertension (50.2%, 95% CI 46.1-54.3) and obesity (46.5%, 95% CI 41.1-52.0). For those individuals without any risk factors at baseline, the lifetime risk of CKD was lower (34.2%, 95% CI 29.4-39.0) relative to those with 1, 2 or 3 risk factors (45.0, 51.5 and 56.1% respectively, P < 0.01 for all compared with those with no risk factors). CONCLUSIONS: Four out of 10 individuals without CKD at age 50 years will eventually develop CKD. This risk is modified by the presence of hypertension, diabetes and obesity at baseline. This demonstrates the importance of early identification of CKD risk factors, to aid in patient education, and potentially to reduce the future risk of disease. Published by Oxford University Press on behalf of ERA-EDTA 2016. This work is written by US Government employees and is in the public domain in the US.
BACKGROUND: An accurate estimation of the lifetime risk of chronic kidney disease (CKD) can aid in patient education while also informing the development of public health screening programs and educational campaigns. METHODS: Framingham Offspring Study participants were included if they were free of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) at age 50 years and had at least two serum creatinine measures during follow-up (mean 16 years, 49 506 person-years). We estimated the lifetime risk of CKD to age 90 years adjusting for the competing risk of death in the overall cohort and in population subgroups with known CKD risk factors including hypertension, obesity and diabetes. RESULTS: Overall 3362 individuals (52% women) were included in the study. Mean age at study baseline was 54 years. By the end of the study, 729 individuals (21.7%) developed CKD and 618 (18.4%) died. At age 50 years, the cumulative lifetime risk of CKD was 41.3% [95% confidence interval (CI) 38.5-44.0]. The risk was increased in those with risk factors at baseline including diabetes (52.6%, 95% CI 44.8-60.4), hypertension (50.2%, 95% CI 46.1-54.3) and obesity (46.5%, 95% CI 41.1-52.0). For those individuals without any risk factors at baseline, the lifetime risk of CKD was lower (34.2%, 95% CI 29.4-39.0) relative to those with 1, 2 or 3 risk factors (45.0, 51.5 and 56.1% respectively, P < 0.01 for all compared with those with no risk factors). CONCLUSIONS: Four out of 10 individuals without CKD at age 50 years will eventually develop CKD. This risk is modified by the presence of hypertension, diabetes and obesity at baseline. This demonstrates the importance of early identification of CKD risk factors, to aid in patient education, and potentially to reduce the future risk of disease. Published by Oxford University Press on behalf of ERA-EDTA 2016. This work is written by US Government employees and is in the public domain in the US.
Entities:
Keywords:
body mass index; chronic renal insufficiency; diabetes mellitus; epidemiology; hypertension