American Journal of Kidney Diseases

Predictors in Adolescence of ESRD in Middle-Aged Men

  • Per-Ola Sundin
    Address correspondence to Per-Ola Sundin, MD, Medicinska kliniken, Örebro University Hospital, 701 85 Örebro, Sweden.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden

    Department of Medicine, Örebro University Hospital, Örebro, Sweden
    Search for articles by this author
  • Ruzan Udumyan
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden

    Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden
    Search for articles by this author
  • Per Sjöström
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden
    Search for articles by this author
  • Scott Montgomery
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden

    Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden

    Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

    Department of Epidemiology and Public Health, University College, London, United Kingdom
    Search for articles by this author
Published:August 12, 2014DOI:


      Identification of predictors of end-stage renal disease (ESRD) in adolescence could provide intervention targets and improve understanding of the cause.

      Study Design

      Register-based nested case-control study.

      Setting & Participants

      A cohort of all Swedish male residents born from 1952 through 1956 who attended mandatory military conscription examinations in late adolescence was used to identify 534 cases and 5,127 controls matched by birth year, county, and vital status.


      Erythrocyte sedimentation rate (ESR), proteinuria, blood pressure, and body mass index (BMI) in late adolescence.


      ESRD (defined here as dialysis therapy, kidney transplantation, surgical procedures creating long-term access for dialysis therapy, or chronic kidney disease stage 5) from 1985 through 2009.


      Physical working capacity and cognitive function score in late adolescence. Head of household’s occupation and household crowding measured as person-per-room ratio from the 1960 census when participants were children.


      Proteinuria is associated notably with future ESRD, with an adjusted OR of 7.72 (95% CI, 3.94-15.14; P < 0.001) for trace or positive dipstick findings. ESR has a dose-dependent association with ESRD with an adjusted OR of 2.07 (95% CI, 1.14-3.75; P = 0.02) for ESR > 15 mm/h. Hypertension is associated strongly with future ESRD with an OR of 3.97 (95% CI, 2.08-7.59; P < 0.001) for grade 2 hypertension and higher. Elevated BMI is associated statistically significantly with increased ESRD risk with an OR of 3.53 (95% CI, 2.04-6.11; P < 0.001) for BMI ≥ 30 compared with 18.5-<25 kg/m2.


      The study was limited to men, with no initial estimation of glomerular filtration rate, and information on smoking was unavailable.


      ESR, proteinuria, BMI, and blood pressure in late adolescence are independent predictors of ESRD in middle-aged men. This highlights the long natural history and importance of adopting a life-course approach when considering the cause of chronic kidney disease.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Collins A.J.
        • Foley R.N.
        • Herzog C.
        • et al.
        US Renal Data System 2012 Annual Data Report.
        Am J Kidney Dis. 2013; 61: e1-e480
        • Valderrabano F.
        • Jofre R.
        • Lopez-Gomez J.M.
        Quality of life in end-stage renal disease patients.
        Am J Kidney Dis. 2001; 38: 443-464
        • Andersen A.R.
        • Christiansen J.S.
        • Andersen J.K.
        • Kreiner S.
        • Deckert T.
        Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study.
        Diabetologia. 1983; 25: 496-501
        • Wang Y.
        • Chen X.
        • Song Y.
        • Caballero B.
        • Cheskin L.J.
        Association between obesity and kidney disease: a systematic review and meta-analysis.
        Kidney Int. 2008; 73: 19-33
        • Klag M.J.
        • Whelton P.K.
        • Randall B.L.
        • et al.
        Blood pressure and end-stage renal disease in men.
        N Engl J Med. 1996; 334: 13-18
        • Haroun M.K.
        • Jaar B.G.
        • Hoffman S.C.
        • Comstock G.W.
        • Klag M.J.
        • Coresh J.
        Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland.
        J Am Soc Nephrol. 2003; 14: 2934-2941
        • Elsayed E.F.
        • Tighiouart H.
        • Griffith J.
        • et al.
        Cardiovascular disease and subsequent kidney disease.
        Arch Intern Med. 2007; 167: 1130-1136
        • Diamond J.R.
        Analogous pathobiologic mechanisms in glomerulosclerosis and atherosclerosis.
        Kidney Int Suppl. 1991; 31: S29-S34
        • Keane W.F.
        • Kasiske B.L.
        • O'Donnell M.P.
        Lipids and progressive glomerulosclerosis. A model analogous to atherosclerosis.
        Am J Nephrol. 1988; 8: 261-271
        • Ross R.
        Atherosclerosis—an inflammatory disease.
        N Engl J Med. 1999; 340: 115-126
        • Remuzzi G.
        • Bertani T.
        Pathophysiology of progressive nephropathies.
        N Engl J Med. 1998; 339: 1448-1456
        • Berenson G.S.
        • Srinivasan S.R.
        • Bao W.
        • Newman III, W.P.
        • Tracy R.E.
        • Wattigney W.A.
        Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.
        N Engl J Med. 1998; 338: 1650-1656
      1. Bergh C, Udumyan R, Fall K, Nilsagard Y, Appelros P, Montgomery S. Stress resilience in male adolescents and subsequent stroke risk: cohort study [published online ahead of print March 28, 2014]. J Neurol Neurosurg Psychiatry.

        • Montgomery S.
        • Udumyan R.
        • Magnuson A.
        • Osika W.
        • Sundin P.O.
        • Blane D.
        Mortality following unemployment during an economic downturn: Swedish register-based cohort study.
        BMJ Open. 2013; 3: e003031
        • Whitworth J.A.
        • World Health Organization, International Society of Hypertension Writing Group
        2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.
        J Hypertens. 2003; 21: 1983-1992
      2. Statistics Sweden. Folk- och bostadsräkningar. Accessed March 29, 2014.

        • Ludvigsson J.F.
        • Andersson E.
        • Ekbom A.
        • et al.
        External review and validation of the Swedish national inpatient register.
        BMC Public Health. 2011; 11: 450
      3. National Board of Health and Welfare. The National Patient Register. Accessed March 29, 2014.

        • Ridker P.M.
        • Brown N.J.
        • Vaughan D.E.
        • Harrison D.G.
        • Mehta J.L.
        Established and emerging plasma biomarkers in the prediction of first atherothrombotic events.
        Circulation. 2004; 109: IV6-IV19
        • Pai J.K.
        • Pischon T.
        • Ma J.
        • et al.
        Inflammatory markers and the risk of coronary heart disease in men and women.
        N Engl J Med. 2004; 351: 2599-2610
        • Toss F.
        • Nordstrom A.
        • Nordstrom P.
        Inflammation in young adulthood is associated with myocardial infarction later in life.
        Am Heart J. 2013; 165: 164-169
        • Schrier R.W.
        Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor?.
        J Am Coll Cardiol. 2006; 47: 1-8
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.-y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Shlipak M.G.
        • Fried L.F.
        • Crump C.
        • et al.
        Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency.
        Circulation. 2003; 107: 87-92
        • Bash L.D.
        • Erlinger T.P.
        • Coresh J.
        • Marsh-Manzi J.
        • Folsom A.R.
        • Astor B.C.
        Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study.
        Am J Kidney Dis. 2009; 53: 596-605
        • Shankar A.
        • Sun L.
        • Klein B.E.
        • et al.
        Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study.
        Kidney Int. 2011; 80: 1231-1238
        • Hiramoto J.S.
        • Katz R.
        • Peralta C.A.
        • et al.
        Inflammation and coagulation markers and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am J Kidney Dis. 2012; 60: 225-232
        • Hillege H.L.
        • Fidler V.
        • Diercks G.F.
        • et al.
        Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population.
        Circulation. 2002; 106: 1777-1782
        • Hallan S.I.
        • Matsushita K.
        • Sang Y.
        • et al.
        Age and association of kidney measures with mortality and end-stage renal disease.
        JAMA. 2012; 308: 2349-2360
        • Nitsch D.
        • Grams M.
        • Sang Y.
        • et al.
        Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.
        BMJ. 2013; 346: f324
        • Fink H.A.
        • Ishani A.
        • Taylor B.C.
        • et al.
        Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: a systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline.
        Ann Intern Med. 2012; 156: 570-581
        • Huang Y.
        • Cai X.
        • Zhang J.
        • et al.
        Prehypertension and incidence of ESRD: a systematic review and meta-analysis.
        Am J Kidney Dis. 2014; 63: 76-83
        • Silverwood R.J.
        • Pierce M.
        • Hardy R.
        • et al.
        Early-life overweight trajectory and CKD in the 1946 British birth cohort study.
        Am J Kidney Dis. 2013; 62: 276-284
        • Vivante A.
        • Golan E.
        • Tzur D.
        • et al.
        Body mass index in 1.2 million adolescents and risk for end-stage renal disease.
        Arch Intern Med. 2012; 172: 1644-1650
        • Cass A.
        • Cunningham J.
        • Wang Z.
        • Hoy W.
        Social disadvantage and variation in the incidence of end-stage renal disease in Australian capital cities.
        Aust N Z J Public Health. 2001; 25: 322-326
        • Perneger T.V.
        • Whelton P.K.
        • Klag M.J.
        Race and end-stage renal disease. Socioeconomic status and access to health care as mediating factors.
        Arch Intern Med. 1995; 155: 1201-1208
        • Choi A.I.
        • Weekley C.C.
        • Chen S.C.
        • et al.
        Association of educational attainment with chronic disease and mortality: the Kidney Early Evaluation Program (KEEP).
        Am J Kidney Dis. 2011; 58: 228-234
        • Fored C.M.
        • Ejerblad E.
        • Fryzek J.P.
        • et al.
        Socio-economic status and chronic renal failure: a population-based case-control study in Sweden.
        Nephrol Dial Transplant. 2003; 18: 82-88
        • White S.L.
        • Dunstan D.W.
        • Polkinghorne K.R.
        • Atkins R.C.
        • Cass A.
        • Chadban S.J.
        Physical inactivity and chronic kidney disease in Australian adults: the AusDiab Study.
        Nutr Metab Cardiovasc Dis. 2011; 21: 104-112
        • Stengel B.
        • Tarver-Carr M.E.
        • Powe N.R.
        • Eberhardt M.S.
        • Brancati F.L.
        Lifestyle factors, obesity and the risk of chronic kidney disease.
        Epidemiology. 2003; 14: 479-487
        • Hallan S.
        • de Mutsert R.
        • Carlsen S.
        • Dekker F.W.
        • Aasarod K.
        • Holmen J.
        Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable?.
        Am J Kidney Dis. 2006; 47: 396-405
        • Park M.
        • Ko Y.
        • Song S.H.
        • Kim S.
        • Yoon H.J.
        Association of low aerobic fitness with hyperfiltration and albuminuria in men.
        Med Sci Sports Exerc. 2013; 45: 217-223
        • Luyckx V.A.
        • Bertram J.F.
        • Brenner B.M.
        • et al.
        Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease.
        Lancet. 2013; 382: 273-283