Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
Departments of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Ill.
Am J Med. 2023 Apr;136(4):380-389.e10. doi: 10.1016/j.amjmed.2022.12.001. Epub 2022 Dec 22.
There may be nontraditional pathways of chronic kidney disease (CKD) progression that are complementary to classical pathways. Therefore, we aimed to examine nontraditional risk factors for incident CKD and its progression.
We used the generally healthy population (n = 4382) starting at age 27-41 years in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, which is an observational longitudinal study. Nontraditional risk factors included forced vital capacity, inflammation, serum urate, and serum carotenoids. CKD risk category was classified using the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) measured in 1995-1996 and repeated every 5 years for 20 years: No CKD, low risk, moderate risk, high risk, and very high risk.
At baseline, 84.8% had no CKD (eGFR ≥60 mL/min/1.73 m and UACR <10 mg/g), 10.3% were in the low risk (eGFR ≥60 and UACR 10-29), and 4.9% had CKD (eGFR <60 and/or UACR ≥ 30). Nontraditional risk factors were significantly associated with the progression of CKD to higher categories. Hazard ratios per standard deviation of the predictor for incident CKD and its progression from the No CKD and low and moderate risk into CKD were inverse for forced vital capacity and serum carotenoids and positive for serum urate, GlycA, and C-reactive protein, the first 3 even after adjustment for conventional risk factors.
Several nontraditional markers were significantly associated with an increased risk of progression to higher CKD categories in generally healthy young to middle-aged adults.
慢性肾脏病（CKD）的进展可能存在非传统途径，这些途径与经典途径相辅相成。因此，我们旨在研究非传统危险因素与 CKD 发病和进展的关系。
我们使用了冠状动脉风险发展在年轻人（CARDIA）队列中的一般健康人群（n=4382），年龄在 27-41 岁之间，该队列是一项观察性纵向研究。非传统危险因素包括用力肺活量、炎症、血清尿酸和血清类胡萝卜素。使用 1995-1996 年测量的估计肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）以及每 5 年重复 20 年的方法对 CKD 风险类别进行分类：无 CKD、低风险、中风险、高风险和极高风险。
在基线时，84.8%的人没有 CKD（eGFR≥60mL/min/1.73m，UACR<10mg/g），10.3%的人处于低风险（eGFR≥60，UACR 10-29），4.9%的人患有 CKD（eGFR<60 和/或 UACR≥30）。非传统危险因素与 CKD 向更高类别进展显著相关。预测因子每标准差与无 CKD 和低、中风险进入 CKD 的新发 CKD 及其进展的风险比呈负相关，用力肺活量和血清类胡萝卜素呈负相关，血清尿酸、GlycA 和 C-反应蛋白呈正相关，前 3 项甚至在调整了传统危险因素后仍然如此。
在一般健康的年轻到中年成年人中，几种非传统标志物与向更高的 CKD 类别进展的风险增加显著相关。
