Changes in renal risk factors versus renal function outcome during follow-up in a population-based cohort study.
BACKGROUND
Chronic kidney disease is a growing public health problem worldwide. Previous studies have identified several predictors for renal function decline. However, these studies used a single measurement of these risk factors. Therefore, the aim of this study was to investigate whether besides the baseline values of these risk factors, changes in risk factors are associated with subsequent rate of renal function loss.


METHODS
Five thousand, six hundred and fifty-one participants in the Prevention of Renal and Vascular ENd-stage Disease (PREVEND) Study, a prospective, community-based cohort study, completed three screening visits during a follow-up of 6.5 years for detailed clinical and biochemical measurements. Change in renal function between the second and third screening rounds was chosen as the study parameter of interest. Changes in risk factors between the first and second screening rounds were incorporated as potential predictors for renal function loss in multivariable linear regression analyses. Based on the results of a previous study, gender-specific analyses were performed.


RESULTS
In males, an increase in urinary albumin excretion (UAE), systolic blood pressure (SBP) and cholesterol was associated with a subsequent higher rate of renal function loss, whereas in females, increases in glucose levels were associated with an increase in renal function. For males, the analyses showed that both the baseline values and the change in UAE and cholesterol were significant predictors for increased rate of renal function loss during subsequent follow-up. With respect to SBP, when taking also the change in this variable into account, the baseline value was no longer a significant predictor for renal function loss.


CONCLUSIONS
The results of the present study show the value of screening programs including repeated measurements of risk factors. Furthermore, these data indicate that, besides baseline values of risk factors, the changes over time in these factors should also be taken into account when developing 'Renal Risk Scores' to identify subjects in the general population who are at risk for accelerated renal function deterioration.
Halbesma
Nynke
N
Division of Nephrology, Department of Medicine, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
Jansen
Desiree F
DF
Stolk
Ronald P
RP
De Jong
Paul E
PE
Gansevoort
Ronald T
RT
D000328:Adult; D000419:Albuminuria / Q000150:complications; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000503:physiopathology*; D012307:Risk Factors; D012727:Sex Characteristics
D002784:Cholesterol