title: Risk factor profile for chronic kidney disease is similar to risk factor profile for small artery disease.
abstract: METHODS
  We investigated whether chronic kidney disease detected by increased serum creatinine (S(Cr)) or urine albumin-to-creatinine ratio (U(ACR)) 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 S(Cr) and U(ACR) 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 S(Cr) and U(ACR) 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 S(Cr) and U(ACR) were disproportionate to their relative contributions to prediction of decreased ABI (P < 0.0001).
  
  
  CONCLUSIONS
  The findings support the view that chronic kidney disease detected by increased S(Cr) or U(ACR) primarily reflects small vessel arteriosclerosis involving the kidneys.
authors: Division of Nephrology and Hypertension, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. turner.stephen@mayo.edu
authors: Stephen T
authors: ST
authors: Turner
authors: Andrew D
authors: AD
authors: Rule
authors: Gary L
authors: GL
authors: Schwartz
authors: Iftikhar J
authors: IJ
authors: Kullo
authors: Thomas H
authors: TH
authors: Mosley
authors: Clifford R
authors: CR
authors: Jack
authors: Sharon L R
authors: SL
authors: Kardia
authors: Eric
authors: E
authors: Boerwinkle
authors: Kent R
authors: KR
authors: Bailey
mesh_terms: D000368:Aged; D001158:Arteries / Q000473:pathology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology*