Kidney disease is defined as a glom...

Kidney disease is defined as a glomerular filtration rate (GFR) of les than 60 mL by minute per 1.73 [m.sup.2]. The condition is used by all in the United States and many times progresses to end-stage renal disease (ESRD) Fox and associates investigated risk factors associated with incident kidney disease to help identify modifiable precursors.

Investigators for the Framingham Off-spring meditation enrolled 5,124 men and women who were examined each four years. In the study's subset women with a GFR greater than 5925 mL by minute per 1.73 [m.sup.2] and men with a GFR greater than 6435 mL by means of minute per 1.73 [m.sup.2] were included. The issue of interest was the unravelling of a GFR below these cut-points 12 years after baseline. Risk factors similar as diabetes, impaired glucose tolerance, elevated life-blood pressure, abnormal lipid panel, smoking, and increased carcass mass index (BMI) also were evaluated.

Of 2585 participants who were available for follow-up (mean follow-up 185 years), the 244 who perform the operations indicated ined kidney disease were more likely to be older and to have a higher BMI, a higher total cholesterol flat and a higher prevalence of diabetes and hyper-tension than patients without incident kidney disease. Of note, those who were being treated with angiotensin-converting enzyme inhibitors at baseline had baseline GFR values similar to those in patients who were treated with beta blocker and calcium channel blocker moreover had higher GFR values, were les likely to vapor and had lower total cholesterol flats at follow-up.

Among participants whose baseline GFR was les than 90 mL through minute per 1.73 [m.sup.2], 14 percent bring outed kidney disease; those whose baseline GFR was les than 90 mL by minute per 1.73 [m.sup.2] had a threefold increase in the not divisible by 2s of developing kidney disease. Eight percent of participants whose baseline GFR was 90 to 119 mL by minute per 1.73 [m.sup.2] and 4 percent of those whose baseline GFR was 120 mL by minute per 1.73 [m.sup.2] or higher bring outed kidney disease. Baseline predictors of kidney disease included age, systolic vital current pressure, hypertension, hypertension treatment, BMI, high-density lipoprotein cholesterol flush smoking, and diabetes. In multivariate analysis, predictors of developing kidney disease included age, diabetes, BMI, and smoking. Long-term averaged hypertension increased the not divisible by 2s of developing kidney disease by the agency of 57 percent.

Established cardiovascular risk factors, as well as a mildly reduc baseline GFR predicted the increase of kidney disease. Diabetes, which is an established risk factor for end-stage renal disease, is also, to a less degree, a risk factor for new-onset kidney disease. Although hypertension is a risk factor for kidney disease, previous studies have not shown that rigorous direct of blood pressure slows the decline of GFR The possibility that earlier intervention would make a difference has over and above to be clarified.

The authors gather that established cardiovascular disease risk factors are associated with the progress to maturity of new-onset kidney disease. Their inquiry differs from previous studies in that it evaluated risk factors for the increase of new-onset rather than more advanced kidney disease. Baseline GFR correlates with risk of developing kidney disease. However, it is unclear what kind of early interventions would heavy disease progression.

Fox C et al. Predictors of new-onset kidney disease in a community-based population. JAMA February 18 2004;291:84450

COPYRIGHT 2004 American Academy of Family Physicians

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