Context Kidney disease is associated with an increased risk for the development
of cardiovascular disease and end-stage renal disease; however, risk factors
for kidney disease have not been well studied.
Objective To identify predictors of the development of new-onset kidney disease.
Design, Setting, and Participants A community-based, longitudinal cohort study of 2585 participants who
attended both a baseline examination in 1978-1982 and a follow-up examination
in 1998-2001, and who were free of kidney disease at baseline.
Main Outcome Measures Kidney disease was assessed by the Modification of Diet in Renal Disease
Study equation and defined by a glomerular filtration rate (GFR) in the fifth
or lower percentile (≤59.25 mL/min per 1.73 m2 in women, ≤64.25
mL/min per 1.73 m2 in men). Stepwise logistic regression was used
to determine the impact of risk factors on the occurrence of new-onset kidney
disease. Baseline and long-term, 12-year, averaged risk factor models were
Results At baseline, there were 1223 men and 1362 women, with a mean age of
43 years, who were free of preexisting kidney disease. After a mean follow-up
of 18.5 years, 244 participants (9.4%) had developed kidney disease. In multivariable
models, baseline age (odds ratio [OR], 2.36 per 10-year increment; 95% confidence
interval [CI], 2.00-2.78), GFR (<90 mL/min per 1.73 m2: OR,
3.01; 95% CI, 1.98-4.58; 90-119 mL/min per 1.73 m2: OR, 1.84; 95%
CI, 1.16-2.93), body mass index (OR, 1.23 per 1 SD; 95% CI, 1.08-1.41), diabetes
(OR, 2.60; 95% CI, 1.44-4.70), and smoking (OR, 1.42; 95% CI, 1.06-1.91) were
related to the development of kidney disease. In addition to baseline age
and GFR, the long-term, averaged risk factors that were predictive of kidney
disease included hypertension (OR, 1.57; 95% CI, 1.17-2.12), high-density
lipoprotein cholesterol level (OR, 0.80 per 1 SD; 95% CI, 0.69-0.92), and
diabetes (OR, 2.38; 95% CI, 1.45-3.92). Compared with a normal GFR (≥120
mL/min per 1.73 m2), a mildly reduced GFR (<90 mL/min per 1.73
m2) predicted a 3-fold odds of progression to kidney disease (OR,
2.95; 95% CI, 1.94-4.49).
Conclusions Established cardiovascular disease risk factors are associated with
the development of new-onset kidney disease. Patients with a mildly reduced
GFR should be monitored for progression to kidney disease.