TY - JOUR
T1 - Risk factor profile for chronic kidney disease is similar to risk factor profile for small artery disease
AU - Turner, Stephen T.
AU - Rule, Andrew D.
AU - Schwartz, Gary L.
AU - Kullo, Iftikhar J.
AU - Mosley, Thomas H.
AU - Jack, Clifford R.
AU - Kardia, Sharon L.R.
AU - Boerwinkle, Eric
AU - Bailey, Kent R.
PY - 2011/9
Y1 - 2011/9
N2 - BACKGROUND AND METHOD: We investigated whether chronic kidney disease detected by increased serum creatinine (SCr) or urine albumin-to-creatinine ratio (UACR) may reflect arteriosclerosis involving the kidneys. The sample consisted of 1585 members of sibships (804 non-Hispanic whites and 781 non-Hispanic blacks) in which at least two siblings had primary hypertension. We first evaluated the correlations of increased SCr and UACR with the presence of cerebral small vessel arteriosclerosis, which was determined by increased subcortical white matter hyperintensity (WMH) volume on brain magnetic resonance imaging; and with peripheral large vessel arteriosclerosis, which was determined by decreased ankle-brachial index (ABI). After age adjustment, increased SCr and UACR correlated with increased WMH volume (0.54 and 0.52, respectively) and with decreased ABI (0.50 and 0.54, respectively; all P<0.001). We then used logistic regression to evaluate the dependency of each measure of disease on conventional risk factors for arteriosclerosis to assess whether the risk factors' effects were proportional across different measures of disease. Results: Age, race, sex, hypertension, diabetes, total cholesterol, and smoking made similar overall contributions to the prediction of each measure of disease, as judged by the model C-statistics, which varied in a narrow range from 0.84 to 0.85 (all P<0.001). However, the relative contributions that the modifiable risk factors, including hypertension, diabetes, total cholesterol, and smoking made to prediction of increased SCr and UACR were disproportionate to their relative contributions to prediction of decreased ABI (P<0.0001). Conclusion:: The findings support the view that chronic kidney disease detected by increased SCr or UACR primarily reflects small vessel arteriosclerosis involving the kidneys.
AB - BACKGROUND AND METHOD: We investigated whether chronic kidney disease detected by increased serum creatinine (SCr) or urine albumin-to-creatinine ratio (UACR) may reflect arteriosclerosis involving the kidneys. The sample consisted of 1585 members of sibships (804 non-Hispanic whites and 781 non-Hispanic blacks) in which at least two siblings had primary hypertension. We first evaluated the correlations of increased SCr and UACR with the presence of cerebral small vessel arteriosclerosis, which was determined by increased subcortical white matter hyperintensity (WMH) volume on brain magnetic resonance imaging; and with peripheral large vessel arteriosclerosis, which was determined by decreased ankle-brachial index (ABI). After age adjustment, increased SCr and UACR correlated with increased WMH volume (0.54 and 0.52, respectively) and with decreased ABI (0.50 and 0.54, respectively; all P<0.001). We then used logistic regression to evaluate the dependency of each measure of disease on conventional risk factors for arteriosclerosis to assess whether the risk factors' effects were proportional across different measures of disease. Results: Age, race, sex, hypertension, diabetes, total cholesterol, and smoking made similar overall contributions to the prediction of each measure of disease, as judged by the model C-statistics, which varied in a narrow range from 0.84 to 0.85 (all P<0.001). However, the relative contributions that the modifiable risk factors, including hypertension, diabetes, total cholesterol, and smoking made to prediction of increased SCr and UACR were disproportionate to their relative contributions to prediction of decreased ABI (P<0.0001). Conclusion:: The findings support the view that chronic kidney disease detected by increased SCr or UACR primarily reflects small vessel arteriosclerosis involving the kidneys.
KW - albuminuria
KW - ankle-brachial blood pressure index
KW - arteriosclerosis
KW - blood pressure
KW - glomerular filtration rate
KW - hypertension
KW - subcortical white matter hyperintensity
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UR - http://www.scopus.com/inward/citedby.url?scp=80051932734&partnerID=8YFLogxK
U2 - 10.1097/HJH.0b013e328349052b
DO - 10.1097/HJH.0b013e328349052b
M3 - Article
C2 - 21720267
AN - SCOPUS:80051932734
SN - 0263-6352
VL - 29
SP - 1796
EP - 1801
JO - Journal of hypertension
JF - Journal of hypertension
IS - 9
ER -