Original Investigation
Pathogenesis and Treatment of Kidney Disease
Risk of Incident ESRD: A Comprehensive Look at Cardiovascular Risk Factors and 17 Years of Follow-up in the Atherosclerosis Risk in Communities (ARIC) Study

https://doi.org/10.1053/j.ajkd.2009.09.006Get rights and content

Background

Diabetes and hypertension are potent risk factors for end-stage renal disease (ESRD). Previous studies suggest that other cardiovascular risk factors also may increase the risk of ESRD; however, risk associated with a comprehensive cardiovascular risk-factor assessment has not been quantified in a population-based sample.

Study Design

The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort.

Setting & Participants

15,324 white and African American participants aged 45-64 years from 4 US communities were followed up after a baseline visit that occurred in 1987-1989.

Predictor

A comprehensive collection of cardiovascular risk factors were examined.

Outcomes & Measurements

Incidence of ESRD (transplant, dialysis, catheter placement or kidney failure, and death) exclusive of acute kidney failure was ascertained through active surveillance of hospitalizations through 2004.

Results

During a median 16-year follow-up, 241 cases of ESRD developed (incidence rate, 1.04 cases/1,000 person-years). Male sex, African American race, diabetes, hypertension, history of coronary heart disease, smoking, older age, body mass index, and triglyceride concentration were associated with increased risk of ESRD after adjustment for baseline estimated glomerular filtration rate (eGFR) and each other. There was a graded curvilinear association between risk of ESRD and lower baseline eGFR at levels < 90 mL/min/1.73 m2 and moderately increased levels > 120 mL/min/1.73 m2. The relative risk of eGFR on ESRD risk generally was greater in women and individuals with diabetes than in their counterparts.

Limitations

Only events occurring in acute-care hospitals were investigated (but there was long-term continuous active surveillance of events).

Conclusions

We quantify the relative risk of ESRD in a community-based African American and white population associated with established cardiovascular risk factors (diabetes, hypertension, male sex, and African American race) and report prospective data identifying greater risk of ESRD associated with other cardiovascular risk factors: moderately decreased eGFR, increased eGFR, higher body mass index, smoking, and increased triglyceride level.

Section snippets

Study Population

The ARIC Study is a prospective observational cohort of 15,792 self-reported African American and white individuals between the ages of 45 and 64 years from 4 US communities (Forsyth County, NC; Jackson, MS; suburban Minneapolis, MN; and Washington County, MD). Participants took part in examinations starting with a baseline visit (visit 1) between 1987 and 1989. Individuals had 3 follow-up examinations at ∼3-year intervals at community clinics, as well as annual follow-up telephone interviews.

Results

Characteristics of the study population are listed in Table 1. In the 15,324 participants, subsequent ESRD was associated with older age, African American race, male sex, greater SCr level and lower baseline eGFR, diabetes, history of CHD, history of myocardial infarction, hypertension, current (and former) smoking, and greater BMI (Table 1).

During a median of 16 years, 241 cases of ESRD developed (incidence rate, 1.04 case/1,000 person-years; Table 2). Incidence rates were much higher in older

Discussion

This is one of few prospective studies of incident ESRD in a large population-based cohort with substantial follow-up and expands on current knowledge of several ESRD risk factors. We have confirmed known risk factors for ESRD, including African American race, diabetes, hypertension, and older age, but also show strong, independent, and graded relationships with ESRD for less well-studied cardiovascular risk factors, including smoking and serum triglyceride levels. These results also describe

Acknowledgements

The authors thank the staff and participants in the ARIC Study for their important contributions.

Support: ARIC is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. This study was supported in part by grants 5T32-HL-007024-33 (Dr Bash) and 5R01-DK-076770-02 (Dr Astor) from the National Institutes of Health.

Financial Disclosure: None.

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    Originally published online as doi:10.1053/j.ajkd.2009.09.006 on November 23, 2009.

    Because the Editor-in-Chief recused himself from consideration of this manuscript, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

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