Comparative risk of end-stage renal disease, myocardial infarction and stroke in young and older onset diabetes in UK Biobank

Are There Consequences of Adolescent Blood Pressure on Kidney Function in Adulthood?

Background In the last three decades, in people with diabetes, while the mortality and morbidity due to cardiovascular disease (CVD) and stroke have declined, the incidence of end-stage renal disease (ESRD) has crept up. The precise cause for this shift is unknown. Intriguingly, during the same period, the incidence of diabetes in younger people has almost tripled worldwide. This study examines whether young-onset diabetes is a greater risk for ESRD compared to CVD and stroke. Methods We conducted this retrospective cohort study using data from volunteers (n = 502,408) aged 40–69 years recruited in UK Biobank between 2006 and 2010. The exposure variable was the age of diabetes diagnosis, while the outcomes of interest were ESRD, myocardial infarction, angina, and stroke. The cumulative follow-up period from the mean age of diabetes to the mean age of the outcomes of interest was 838,592 person-years. Univariate and multivariate logistic regression models were fitted to assess odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using receiver operating characteristics (ROC) analysis and calibration plots. Findings: Out of 26,206 people with diabetes, 1.16% (n = 303) had ESRD, 8.58% (n = 2250) had a myocardial infarction, 7.47% (n = 1958) had angina, and 2.94% (n = 771) had a stroke. Compared to later-onset, young-onset diabetes is linked with an earlier onset of ESRD. Based on the age of diabetes diagnosis, the univariate logistic regression showed that compared to those diagnosed after the age of 60, the odds of ESRD for those diagnosed at ages < 20, 20–40, and 41–60 years were OR [2.33 (95% CI 1.50–3.84), 7.78 (95% CI 4.81–13.16), and 5.26 (95% CI 3.00–9.40)], respectively. Myocardial infarction and stroke did not have a statistically significant relationship with diabetes diagnosis age. Multivariate models adjusted for sex and albuminuria confirmed the increased odds of ESRD in people with younger onset and longer duration of diabetes. Interpretation: People with younger onset and longer duration of diabetes are at a higher risk of ESRD than CVD and stroke.

Poor accordance to a DASH dietary pattern is associated with higher risk of ESRD among adults with moderate chronic kidney disease and hypertension

Obesity Is Associated With Family History of ESRD in Incident Dialysis Patients

Association between fatty liver index and risk of end-stage renal disease stratified by kidney function in patients with type 2 diabetes: A nationwide population-based study

Kidney Disease in People With Diabetes: The Expanding Epidemic

Treatment of hypertension is difficult in chronic kidney disease (CKD), and blood pressure goals remain controversial. The association between each blood pressure component and end-stage renal disease (ESRD) risk is less well known. We studied associations of systolic and diastolic blood pressure (SBP and DBP, respectively) and pulse pressure (PP) with ESRD risk among 16,129 Kidney Early Evaluation Program (KEEP) participants with an estimated glomerular filtration rate of 60 mL/min/1.73 m(2) using Cox proportional hazards. We estimated the prevalence and characteristics associated with uncontrolled hypertension (SBP ≥ 150 or DBP ≥ 90 mm Hg). The mean (SD) age of participants was 69 (12) years; 25% were black, 6% were Hispanic, and 43% had diabetes mellitus. Over 2.87 years, there were 320 ESRD events. Higher SBP was associated with higher ESRD risk, starting at SBP of 140 mm Hg or higher. After sex and age adjustment, compared with SBP lower than 130 mm Hg, hazard ratios (HRs) were 1.08 (95% CI, 0.74-1.59) for SBP of 130 to 139 mm Hg, 1.72 (95% CI, 1.21-2.45) for SBP of 140 to 149 mm Hg, and 3.36 (95% CI, 2.51-4.49) for SBP of 150 mm Hg or greater. After full adjustment, HRs for ESRD were 1.27 (95% CI, 0.88-1.83) for SBP of 140 to 149 mm Hg and 1.36 (95% CI, 1.02-1.85) for SBP of 150 mm Hg or higher. Persons with DBP of 90 mm Hg or higher were at higher risk for ESRD compared with persons with DBP of 60 to 74 mm Hg (HR, 1.81; 95% CI, 1.33-2.45). Higher PP was also associated with higher ESRD risk (HR, 1.44 [95% CI, 1.00-2.07] for PP ≥ 80 mm Hg compared with PP < 50 mm Hg). Adjustment for SBP attenuated this association. More than 33% of participants had uncontrolled hypertension (SBP ≥ 150 mm Hg or DBP ≥ 90 mm Hg), mostly due to isolated systolic hypertension (54%). In this large, diverse, community-based sample, we found that high SBP seemed to account for most of the risk of progression to ESRD. This risk started at SBP of 140 mm Hg rather than the currently recommended goal of less than 130 mm Hg, and it was highest among those with SBP of at least 150 mm Hg. Treatment strategies that preferentially lower SBP may be required to improve BP control in CKD.

Introduction: Diet soda consumption may be associated with kidney disease, as shown in Caucasian women, due to phosphorus content, by increasing dietary acid load, or as a proxy for poor diet quality. However, less is known about the relationship between diet soda consumption and end-stage renal disease (ESRD) risk in the general population. Methods: We conducted a prospective analysis of time-varying diet soda consumption and incident ESRD in the population-based Atherosclerosis Risk in Communities study (N=15,369) using Cox regression. Usual dietary intake was assessed by a food frequency questionnaire in 1987-89 (baseline) and 1993-95. Incident ESRD was defined as initiation of renal replacement therapy (transplant, dialysis) through 2011. Results: Baseline mean age was 54 years, 55% were female, 27% were African-American, 12% had diabetes, and 35% had hypertension. Approximately a third of participants consumed &lt;1 glass of diet soda per month; 42% of participants consumed up to 6 glasses/week; and 22% consumed more than 6 glasses/week. Over a median follow-up of 23 years, 357 incident ESRD cases were observed. Consuming up to 6 glasses of diet soda per week and more than 6 glasses of diet soda per week, respectively, was associated with 1.28-times (95% CI: 0.96, 1.70; p=0.10) and 1.95-times (95% CI: 1.43, 2.64; p&lt;0.001) greater risk of ESRD relative to &lt;1 glass/month after adjusting for total caloric intake, sugar-sweetened beverages, diet quality, age, sex, race-center, estimated glomerular filtration rate, diabetes, hypertension, overweight/obesity status, education level, smoking status, and physical activity (p-value for trend &lt;0.001; Figure ). For each additional glass of diet soda consumed per day, there was a 26% higher risk of ESRD (HR: 1.26; 95% CI: 1.14, 1.40; p&lt;0.001). Sugar-sweetened beverage consumption was not association with ESRD. Conclusion: Diet soda consumption was associated with ESRD risk and may be an important target for dietary interventions aimed at slowing kidney disease progression.

The renin–aldosterone axis in kidney transplant recipients and its association with allograft function and structure

Introduction: The International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (LN) divides class IV into segmental and global (IV-S and IV-G) based on evidence suggesting different renal outcomes. However, subsequent studies have shown conflicting results. Objective: This study was performed to compare long-term renal outcomes between the IV-S and IV-G classes. Methods: This is a retrospective cohort study of adult patients with biopsy-proven class IV LN using the ISN/RPS classification. The primary end point was end-stage renal disease (ESRD). Results: Among the 89 patients, rapidly progressive glomerulonephritis was twice as frequent in the IV-G group (60 vs. 29%; p = 0.005) than that in the IV-S group. Moreover, the IV-G group had a higher rate of biopsy with cellular and fibrocellular crescents (70.9 vs. 47.1%, p = 0.024) and more crescentic glomerulonephritis (34.5 vs. 5.8%, p = 0.007) than the IV-S group. After a mean follow-up of 57 months, the IV-G group had a greater risk of ESRD (RR 3.9; 95% CI 1.2–12.2, p = 0.006) than the IV-S group. Multivariate analysis indicated that class IV-G was an independent predictor of ESRD. Conclusions: Patients with class IV-G have a higher risk of ESRD than patients with class IV-S.

Background:While it is well established that patients with gout have increased mortality risk compared to the general population [1, 2], even when adjusting for atherosclerotic cardiovascular disease (ASCVD) risk factors...

Background Remnant cholesterol (remnant-C) has been linked to the risk of various vascular diseases, but the association between remnant-C and end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) remains unclear.Methods Using a nationwide cohort, a total of 2,537,149 patients with T2DM without ESRD, who had participated in the national health screening in 2009, were enrolled and followed up until 2020. Low-density lipoprotein cholesterol (LDL-C) levels were assessed by the Martin-Hopkins method, and remnant-C was calculated as total cholesterol–LDL-C–high-density lipoprotein cholesterol.Results During a median follow-up period of 10.3 years, 26,246 patients with T2DM (1.03%) developed ESRD. Participants in the upper quartile of remnant-C had a higher risk of ESRD, with hazard ratios of 1.12 (95% confidence interval [CI], 1.08 to 1.17), 1.20 (95% CI, 1.15 to 1.24), and 1.33 (95% CI, 1.26 to 1.41) in the second, third, and fourth quartile, compared with the lowest quartile, in multivariable-adjusted analyses. The positive association between remnant-C and ESRD remained consistent, irrespective of age, sex, presence of pre-existing comorbidities, and use of anti-dyslipidemic medications. The increased risk of ESRD was more pronounced in high-risk subgroups, including those with hypertension, chronic kidney disease, obesity, and a longer duration of diabetes.Conclusion These findings suggest that remnant-C profiles in T2DM have a predictive role for future progression of ESRD, independent of traditional risk factors for renal dysfunction.

Association between angiotensin II type-1 receptor (AT1R) A1166C gene polymorphism and end-stage renal disease (ESRD) risk is still controversial. This meta-analysis was performed to evaluate the association of AT1R A1166C gene polymorphism with ESRD susceptibility. The search was performed in the databases of PubMed, Embase and Cochrane Library as of 1 May 2012, and the eligible investigations were recruited for this meta-analysis. Nineteen literatures were identified for the analysis of association between AT1R A1166C gene polymorphism and ESRD susceptibility. There was no association between AT1R A1166C gene polymorphism and ESRD susceptibility for overall populations, Caucasians, Asians and Turkish population. Interestingly, CC genotype was associated with a higher risk of ESRD in Africans (OR = 3.36, 95% CI: 1.42–7.99, p = 0.006). However, C allele and AA genotype were not associated with the ESRD risk in African population. In conclusion, CC genotype might be a risk factor for the ESRD susceptibility in African population. However, more case-control association investigations on larger, stratified populations are required in the future.

Blood Pressure Goals: How Low Is Safe in CKD?

Air pollutants and subsequent risk of chronic kidney disease and end-stage renal disease: A population-based cohort study