Renal Failure in Middle-Aged Men Linked to Adolescent Risk Factors

Proteinuria, hypertension, and obesity in adolescence independently predict development of ESRD.
Proteinuria, hypertension, and obesity in adolescence independently predict development of ESRD.

Swedish researchers have identified risk factors present in adolescence that independently predict the risk of end-stage renal disease (ESRD) in middle-aged men.

These factors include proteinuria, erythrocyte sedimentation rate (ESR), blood pressure, and body mass index (BMI).

Proteinuria in adolescence predicted a significant 7.7 times increased adjusted odds of developing ESRD in middle age compared with the absence of proteinuria, researchers reported online ahead of print in the American Journal of Kidney Diseases.

An ESR of 11 mm/h or higher was associated with a significant 2-fold increased odds of ESRD versus an ESR of 1 mm/h. Grade 2-3 hypertension (systolic BP 160 mm Hg or higher and diastolic BP 100 mm Hg or higher) was associated with a significant 4-fold increased odds of ESRD compared with normal blood pressure (systolic BP 120-129 mm Hg and diastolic BP 80-84 mm Hg).

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Compared with a BMI of at least 18.5 but less than 25 kg/m2, men with a BMI of 30 kg/m2 or greater as adolescents had a 3.5 times increased odds of ESRD.

For the study, Per-Ola Sundin, MD,of Örebro University Hospital in Örebro, Sweden, and colleagues use a cohort of Swedish male residents born from 1952 through 1956 who attended mandatory military conscription examinations in late adolescence. From January 1, 1895 through December 31, 2009, the researchers identified 534 ESRD cases and 5,127 controls matched by birth year, county, and vital status.

“Our results support the concept that CKD [chronic kidney disease] often can be traced back into childhood much in parallel to the evidence supporting the onset of atherosclerosis early in life,” the investigators wrote.

The results of this study echo those of a study recently published online ahead of print in the Journal of the American Society of Nephrology. The study, led by Caroline S. Fox, MD, of the National Heart Lung, and Blood Institute's Framingham Heart Study in Framingham, Mass., found that CKD risk factors are identifiable 30 years or more before the diagnosis of CKD. Subjects who developed CKD were significantly more likely than controls without CKD to have had hypertension, obesity, and higher triglyceride levels 30 years before their diagnosis.

“Our results suggest that CKD should be considered a life course disease,” Dr. Fox's group wrote. “Identifying individuals at increased risk of CKD early in life may allow interventions that reduce the risk of CKD. In particular, individuals with multiple risk factors could be targeted for more aggressive risk factor management.”

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