News: Modest reductions in kidney function associated with risk for adverse events, research shows

Modest declines in estimated filtration rate (eGFR) were associated with a 42% increased risk of all-cause mortality, cardiovascular events, and kidney failure for younger adults, according to new research published in The BMJ. Modestly reduced eGFR measurements were recorded for 18% of study participants aged 19-39 years, who then showed a higher hazard ratio around nine years later than older participants, Medscape Medical News reported.

Researchers of the study obtained data for about 8.7 million adults in Ontario, Canada, using healthcare administrative databases, none of whom had a history of kidney disease. They used the current threshold for chronic kidney disease, which is an eGFR of less than 60 mL/min/1.73 m2 for at least 90 days, and stratified participants according to these age-specific eGFR referents:

• Participants aged 18–39 years: 100–110 mL/min/1.73 m2
• Participants aged 40–49 years: 90–100 mL/min/1.73 m2
• Participants aged 50–65 years: 80–90 mL/min/1.73 m2

“[The increased risk] is quite clear, it's across the board, and it starts roughly as you get above 20% to 25% below what normal should be,” senior author Manish M. Sood, MD, professor of medicine at the University of Ottawa and senior scientist at the Ottawa Hospital in Ontario, Canada, told Medscape Medical News. “If we want to prevent future kidney disease, if we want to prevent heart disease, we have to pay attention to these slight decreases in kidney function in young people.”

Previous studies have shown a link between early sustained reduction in eGFR among adults younger than 40 years and premature cardiovascular disease, but these findings show more definitively the link to reduced kidney function and adverse outcomes in this age group due to its population size.

The findings may open a new area of research, according to Sood. “What do we do for these people? We don't know. It's reasonable to at least monitor them more closely and to advise them to adopt a healthy lifestyle, not to start cigarette smoking, stay slim, eat well, exercise, all things we know reduce cardiovascular risk,” he said. “The goal here is to see if we can prevent the onset of more advanced kidney disease. The number one killer of people with kidney disease is actually premature heart disease.”

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To read the BMJ study results, click here.