According to background information provided by the authors, "hypertension and diabetes are the leading causes of end-stage renal disease (ESRD). Among individuals who develop ESRD, the risk of cardiovascular disease is 10 to 20 times higher than the general population, and increased risks are evident even in mild kidney disease." The authors state there are approximately 275,000 patients with ESRD in the U.S. and an estimated 8 million additional U.S. adults have kidney disease.
Caroline S. Fox, M.D., M.P.H., from the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass., and colleagues identified predictors of the development of new-onset kidney disease. The researchers analyzed data from 1,223 men and 1,362 women in the Framingham Offspring Study who had a baseline (initial) examination in 1978 – 1982 and returned for a follow-up examination in 1998 – 2001. None of the participants had kidney disease in the initial examinations. After an average follow-up of 18.5 years, 244 participants (9.4 percent) had developed kidney disease. The researchers defined kidney disease as a decrease in glomerular filtration rate (GFR) [the rate at which the kidneys filter waste] to the fifth percentile or lower, based on national definitions.
The researchers found that established cardiovascular disease risk factors predicted the development of kidney disease. "In addition, a mildly reduced GFR at baseline increased the odds of developing kidney disease. Our data indicate that among unselected participants, diabetes, hypertension, obesity, smoking, low HDL-C level, and a mild reduction in GFR are important risk factors for the development of new-onset kidney disease," the authors write. "Patients with mildly reduced GFR should be monitored for progression to kidney disease."
(JAMA. 2004;291:844-850. Available post-embargo at JAMA.com)
Editor's Note: The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute.
For more information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA (5262) or email: mediarelations@jama-archives.org.
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