Shift work and risk of chronic kidney disease: A systematic review and meta-analysis.

ObjectiveKidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset.MethodsThis study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/or estimated glomerular filtration rate lower than 60 mL/min/1.73 m2. The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender.ResultsThe risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2.34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant.ConclusionsIn this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.

Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease. A systematic review of the Medline/PubMed, Embase, Cochrane Library, and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality. In total, 42 studies (2613971 patients) with a mean age of 43.55±14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep durations of ≤4 hours (RR 1.41, 95% CI: 1.16 to 1.71, P<0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, P<0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, P<0.01), and ≤7 hours (RR 1.19, 95% CI: 1.12 to 1.28, P<0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep durations of ≥8 hours (RR 1.15, 95% CI: 1.03 to 1.28, P<0.01) and ≥9 hours (RR 1.46, 95% CI: 1.28 to 1.68, P<0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region, and BMI and an association with sleep duration and risk of incident chronic kidney disease. Both short and long sleep durations were significantly associated with a higher risk of chronic kidney disease. Interventions targeted toward achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease.

The relationship between the progression of arterial stiffness and the risk of chronic kidney disease (CKD) remains unclear. This study aimed to evaluate the time-dependent association between the progression of arterial stiffness and the risk of CKD. We followed 10,567 individuals in the Kailuan Study, who were free of CKD and CVD at baseline. Arterial stiffness was repeatedly measured by brachial-ankle pulse wave velocity (baPWV) from baseline to the subsequent follow-ups. Time-dependent Cox models were used to estimate the association between progression of arterial stiffness (△baPWV/years) and incident CKD, defined as an eGFR below 60 ml/min per 1.73 m2 and/or the presence of albuminuria. During a mean follow-up of 5.32 years, 1108 participants developed CKD. Lower quintiles in baPWV at baseline and the progression of baPWV over time were associated with a lower risk of CKD in a dose-dependent manner (p-trend <0.001). Compared with participants with the greatest deterioration in arterial stiffness (quintile 5), those with the greatest improvement in arterial stiffness (quintile 1) had a 45% (95% CI 34, 55) lower risk of CKD. Each SD increment in the progression of baPWV was associated with a 19% higher risk of CKD. Additionally, compared with participants who consistently had high baPWV (≥1400 cm/s), participants who maintained low baPWV (<1400 cm/s) or improved from high to low baPWV over time had a 46% (95% CI 33, 57) or 32% (95% CI 12, 48) lower risk of incident CKD, respectively. Adding progression of arterial stiffness to the CKD risk model modestly improved discrimination (optimism-adjusted C statistic from 0.690 to 0.709, p<0.001). In this cohort study, improvement in arterial stiffness, as indicated by a consistently low or decreased baPWV, might be associated with a lower risk of CKD. These findings underscore the potential importance of coordinated actions targeting cardiovascular health to improve kidney health in the general population.

Does Inflammation Fuel the Fire in CKD?

Nutrition and Kidney Health: Processing Emerging Evidence About Foods

Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD. MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression. Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I2 = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10). Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.

BackgroundStillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth.ObjectiveTo identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities.Study Design/MethodsWe conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately.ResultsThere were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9–30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09–1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55–3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13–1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86–4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73–1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78–2.85).ConclusionWomen who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.

Primary Versus Secondary Prevention of Chronic Kidney Disease: The Case of Dietary Protein

Do Children With Acute Kidney Injury Require Long-term Evaluation for CKD?

BackgroundIndividuals in the workplace are exposed to various environments, tasks, and schedules. Previous studies have indicated a link between occupational exposures and an increased risk of chronic kidney disease (CKD). However, the social conditions of the work environment may also be a crucial contributing factor to CKD. Furthermore, individuals may encounter multiple occupational-related risk factors simultaneously, underscoring the importance of investigating the joint risk of different working conditions on CKD.MethodsA prospective analysis of 65,069 UK Biobank participants aged 40 to 69 years without CKD at baseline (2006–2010) was performed. A self-administered questionnaire assessed working conditions and a working conditions risk score were developed. Participants who answered “sometimes” or “often” exposure to occupational heat or occupational secondhand cigarette smoke; involved in shift work or heavy workloads (“usually” or “always”), were grouped as high-risk working conditions. Each working condition was scored as 1 if grouped as high-risk, and 0 if not. The working conditions risk score was equal to the sum of these four working conditions. Cox proportional hazard regression models were used to estimate the associations between working conditions and CKD incidence.ResultsThe mean follow-up time was 6.7 years. After adjusting for demographic, lifestyle, and working time factors, the hazard ratios for the development of CKD for heavy workloads, shift work, occupational secondhand cigarette smoke exposure, and occupational heat exposure were 1.24 (95%CI = 1.03, 1.51), 1.33 (95%CI = 1.10, 1.62), 1.13 (95%CI = 1.01, 1.26), 1.11 (95%CI = 0.99, 1.24), respectively. The risk of CKD was found to be significantly associated with an increasing working conditions risk score. Individuals with a working conditions risk score of 4 had an 88.0% (95% CI = 1.05, 3.35) higher risk of developing CKD when compared to those with a working conditions risk score of 0.ConclusionsAdverse working conditions, particularly when considered in combination, can significantly elevate the risk of chronic kidney disease (CKD). These results provide a reference for implementing measures to prevent CKD.

The association between abdominal visceral adipose tissue and the risk of incident chronic kidney disease according to body mass index in the Asian population, remains unclear. We evaluated the impact of abdominal adiposity stratified by body mass index on the risk of incident chronic kidney disease. A cohort study included 11,050 adult participants who underwent health check-ups and re-evaluated the follow-up medical examination at a single university-affiliated healthcare center. Cross-sectional abdominal adipose tissue areas were measured using computed tomography. The primary outcome was progression to chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73m2). The highest quartile of visceral adipose tissue was used for the cut-off of central obesity. During the mean of 5.6 follow-up years, 104 incident chronic kidney disease cases were identified. The risk for chronic kidney disease incidence was significantly increased in the 3rd and 4th quartile ranges of visceral adipose tissue [hazard ratio (95% confidence interval)]: 4.59 (1.48-14.30) and 7.50 (2.33-24.20), respectively. In the analysis stratified by body mass index, the chronic kidney disease incidence risk was increased in the highest quartile range of visceral adipose tissue in the normal weight group: 7.06 (1.35-37.04). However, there was no significant relationship between visceral adipose tissue and chronic kidney disease in the obese group. Compared to the subjects with normal weight and absent central obesity, the hazard ratio for chronic kidney disease incidence was 2.32 (1.26-4.27) among subjects with normal weight and central obesity and 1.81 (1.03-3.15) among subjects with obesity and central obesity. Visceral adipose tissue was a significant risk factor for subsequent chronic kidney disease progression, and the association was identified only in the normal weight group. Normal-weight central obesity was associated with excess risk of chronic kidney disease, similar to the risk in the group with obesity and central obesity.

Long-term Risk of CKD in Children Surviving Episodes of Acute Kidney Injury in the Intensive Care Unit: A Prospective Cohort Study

Background It is unclear whether individuals with Down syndrome (DS) are at increased risk of kidney disease. This study aims to examine the risk of acute kidney injury (AKI) and chronic kidney disease (CKD) in individuals with DS compared to the general population. Methods Using the Danish Cytogenetic Central Registry, we identified a population-based cohort of individuals with genetically confirmed DS in Denmark between 1961 and 2021. For each individual with DS, we sampled 10 age-and-sex-matched individuals without DS from the general Danish population. We used laboratory data on plasma creatinine from the 1990s until 2024 to assess AKI and CKD and computed the cumulative incidence (risk) of AKI and CKD by age. Furthermore, we estimated the risk of AKI and CKD in individuals without congenital heart disease (CHD). Results We identified 2,815 individuals with DS and available laboratory data on plasma creatinine measurements. Comparing individuals with DS to the matched cohort, the risk of AKI was 28.9% vs. 1.4% at age 20, 32.8% vs. 5.3% at age 40, and 48.6% vs. 23.8% at age 70. The risk of CKD was 1.2% vs. 0.1% at age 20, 3.9% vs. 0.4% at age 40, and 23.2% vs. 13.8% at age 70. For individuals without CHD, the risk of AKI and CKD remained considerably higher for individuals with DS than for matched individuals. Conclusions Individuals with DS were at increased risk of both AKI and CKD compared to the general population. Kidney disease should be considered during clinical follow-up of DS.

Association of Hemoglobin S and C Traits with Kidney Disease in African Americans in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background Hypertensive disorders of pregnancy (HDP) (preeclampsia, gestational hypertension) are increasingly common complications of pregnancy. HDP are associated with increased risk of cardiovascular disease and end-stage kidney disease in women. Chronic kidney disease (CKD) is highly prevalent, but evidence for associations between HDP and CKD is limited and inconsistent. The underlying causes of CKD are wide-ranging, and HDP may have differential associations with various aetiologies of CKD. We aimed to identify whether HDP are associated with CKD and whether this risk differs by CKD aetiology. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973–2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and treated as a time-dependent variable. Gestational hypertension was also investigated as a secondary exposure. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used, adjusting for year of delivery, maternal age, country of origin, education level, antenatal BMI, smoking during pregnancy, gestational diabetes, and parity. Women with pre-pregnancy comorbidities were excluded. Results The final sample consisted of 1,924,409 women who had 3,726,554 singleton live-births. The mean age of women at first delivery was 27.0 (±5.1) years. Median follow-up was 20.7 (interquartile range 9.9–30.0) years. 90,917 women (4.7%) were diagnosed with preeclampsia, 43,964 (2.3%) had gestational hypertension, and 18,477 (0.9%) developed CKD. Women who had preeclampsia had a higher risk of developing CKD during follow-up (adjusted hazard ratio (aHR) 1.92, 95% CI 1.83–2.03). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.72, 95% CI 3.05–4.53), diabetic CKD (aHR 3.94, 95% CI 3.38–4.60) and glomerular/proteinuric CKD (aHR 2.06, 95% CI 1.88–2.26). The risk of CKD was increased after preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity. Women who had gestational hypertension also had increased risk of developing CKD (aHR 1.49, 95% CI 1.38–1.61). Conclusion Women with history of HDP are at increased risk of CKD, particularly hypertensive or diabetic CKD. Preterm preeclampsia, recurrent preeclampsia, and preeclampsia complicated by pre-pregnancy obesity are all associated with higher risk of maternal CKD. Since 10% of women develop clinically significant CKD in their lifetime, the absolute risk of CKD related to HDP may be substantial. Women who experience HDP may benefit from future systematic renal monitoring to prevent CKD onset or progression.