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Original Investigation Pathogenesis and Treatment of Kidney Disease| Volume 64, ISSUE 5, P723-729, November 01, 2014

Predictors in Adolescence of ESRD in Middle-Aged Men

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

    Department of Medicine, Örebro University Hospital, Örebro, Sweden
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  • Ruzan Udumyan
    Affiliations
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden

    Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden
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  • Per Sjöström
    Affiliations
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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  • Scott Montgomery
    Affiliations
    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
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Published:August 12, 2014DOI:https://doi.org/10.1053/j.ajkd.2014.06.019

      Background

      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.

      Predictor

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

      Outcomes

      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.

      Measurements

      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.

      Results

      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.

      Limitations

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

      Conclusions

      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

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