Table 5.2Risk factors for developing CKD

ReferencePopulationNDefinition of CKDRisk factor for developing CKD
146ARIC cohort, USA10,096eGFR < 60 ml/min/1.73m2Metabolic syndrome: elevated triglycerides OR 1.34 (1.12–1.59); abdominal obesity 1.18 (1.00–1.40); low LDL 1.27 (1.08–1.49); hypertension 1.99 (1.69–2.35); impaired fasting glucose 1.11 (0.87–1.40)
148ARIC cohort, USA12,728Rise in serum creatinine of ≥0.4 mg/dl
≥25% reduction in estimated creatinine clearance (Cockroft-Gault)
Atherosclerotic risk markers: comparison is lowest quartile
Highest quartile of triglycerides (>156 mg/dl) RR 1.65 (1.1–2.5), p=0.01
Highest quartile of HDL cholesterol (>64 mg/dl) RR 0.47 (0.3–0.8), p<0.02
Highest quartile of HDL-2 cholesterol (>20 mg/dl) RR 0.57 (0.4–0.9, p<0.02)
The RR of a rise in creatinine ≥0.4 mg/dl from baseline was NS for Lp (a), HDL-3 cholesterol, and apolipoprotein A.
For each three-fold higher triglycerides, the RR of developing a ≥25% reduction in estimated creatinine clearance was 1.51 (95% CI 1.2 to 2.0), p=0.003
147ARIC + CHS, USA13,826Rise in serum creatinine of ≥0.4 mg/dlCardiovascular disease: comparison is people without baseline CVD (N=12039)
People with baseline CVD (N=1787) had a significantly increased risk of developing CKD (adjusted OR 1.75, 95% CI 1.32 to 2.32, p<0.001).
GFR decrease of ≥15 ml/min/1.73 m2Cardiovascular disease: comparison is people without baseline CVD (N=12039)
People with baseline CVD had an increased risk of developing CKD (adjusted OR 1.54, 95% CI 1.26 to 1.89, p<0.001).
144Physician’s Health Study cohort, USA11,104GFR < 60 ml/min/1.73m2Body mass index: compared to BMI <22.7 kg/m2
BMI >26.6 kg/m2 (N=2220) OR 1.26 (1.03 to 1.54)
BMI 25.1–26.6 kg/m2 (N=2250) OR 1.32 (1.09 to 1.61)
NS risk when BMI 22.7–25.0
145Follow-up of NHANES II, USA9,082CKD-related death or ESRDBody mass index: comparison is normal BMI (18.5–24 kg/m2)
NS risk when BMI <18.5 kg/m2, 25–29 kg/m2, 30–34 kg/m2 or >35 kg/m2).
Physical inactivity: comparison is high physical activity
Low physical activity RR 2.2 (1.2 to 4.1).
Moderate physical activity: NS risk
Smoking: compared to non-smokers
Smokers (>20 cigarettes/day) RR 2.6 (1.4 to 4.7).
Smokers (1–20 cigarettes/day) have NS risk
Former smokers have NS risk
Alcohol consumption: compared to non-drinkers
NS risk for daily drinkers or weekly drinkers or people who seldom drank
10Cross-sectional Southampton and South-west Hampshire, UK404,541Serum creatinine value >1.7 mg/dl or >150 μmol/l persisting for six months or moreThe incidence of CKD was 1701 pmp, 95% CI 1613 to 1793 pmp). For people <80 years old, the incidence was 1071 pmp (95% CI 1001 to 1147).
Age: The incidence of CKD increased with increasing age. 74% of CKD cases were identified in people ≥70 years old.
Gender: The man:woman rate ratio was 1.6 (95% CI 1.4 to 1.8). The preponderance of men with CKD was significant in all ages >40 years of age.
Socioeconomic deprivation: compared with overall population
Least deprived directly standardised rate ratio 0.80 (95% CI 0.69 to 0.93)
Most deprived directly standardised rate ratio 1.17, 95% CI 1.02 to 1.33)
143Cross-sectional; Surrey, Kent, greater Manchester area, UK162,113GFR <60 ml/min/1.73m2The prevalence of diabetes was 3.1% (5072/162,113).
Diabetes: 31.3% of people with diabetes had stage 3–5 CKD (GFR <60 ml/min/1.73 m2) compared to 6.9% of people without diabetes (p<0.001). The higher prevalence of diabetes-associated CKD was seen at all stages of CKD.
141Cross-sectional, Australia11,247GFR <60 ml/min/1.73m2The prevalence of stage 1 CKD in Australia was 0.9%, stage 2 was 2.0%, stage 3 was 10.9%, stage 4 was 0.3%, stage 5 was 0.003%.
Age: compared with people <65
People ≥65 years OR 101.5 (61.4–162.9, p<0.001)
Gender: females OR 1.3 (1.0–1.7), p=0.012
Diabetes: compared to people without diabetes
People with diabetes had NS risk: OR 0.9 (0.7–1.1, p=0.308)
Hypertension: compared to normotensive people
People with hypertension: OR 1.4 (1.2–1.6, p<0.001)
20Cross-sectional NHANES III, USA15,600GFR 60–89 ml/min/1.73m2
Moderate CKD (GFR 30–59 ml/min/1.73m2)
Severe CKD (GFR 15–29 ml/min/1.73m2)
The prevalence of stage 1 CKD in the USA was 3.3%, stage 2 was 3.0%, stage 3 was 4.3%, stage 4 was 0.2%, stage 5 was 0.2%. The overall prevalence of CKD in USA was 11%.
Age: 48% of people >70 years of age (N=2965) had mild CKD (GFR 60–89 ml/min/1.73m2) and 25% had moderate to severe CKD (GFR <60 ml/min/1.73m2).
Gender: NS difference in prevalence between males and females
Hypertension: 17.5% of hypertensive people taking antihypertensive agents (N=2553) and 7.9% of hypertensive people not taking medication (2340) had moderate CKD (GFR 30–59 ml/min/1.73m2) compared to 1.5% of non-hypertensive people (N=10,707).
Diabetes: 40% of people with diabetes had mild CKD (GFR 60–89 ml/min/1.73m2) whereas 31% of people without diabetes had mild CKD (GFR 60–89 ml/min/1.73m2). 14% of people with diabetes had moderate CKD (GFR 30–59 ml/min/1.73m2) whereas 3.7% of people without diabetes had moderate CKD (GFR 30–59 ml/min/1.73m2).
Ethnicity: compared to non-Hispanic white people, non-Hispanic black people (N=4163) were significantly less likely to have moderate CKD (GFR 30–59 ml/min/1.73m2) adjusted OR 0.56 (0.44 to 0.71).
There was NS difference in prevalence of severe CKD (GFR 15–29 ml/min/1.73m2) in non-Hispanic black or white people (adjusted OR 1.10, 95% CI 0.51 to 2.37).
140Cross-sectional, Norway HUNT II65,181GFR <60 ml/min/1.73m2The prevalence of GFR 60–89 ml/min/1.73m2 was 38.6%. The prevalence of moderate CKD (GFR 30–59 ml/min/1.73m2) was 4.5% and severe CKD (GFR 15–29 ml/min/1.73m2) was 0.2%.
Age: The prevalence of GFR <60 ml/min/1.73m2 was 50–100 times greater in people >70 years old compared to people 20–39 years old.
Gender: Women age-adjusted OR 1.5 (1.4–1.6).
Hypertension: compared with normotensives
Hypertension age-adjusted OR 1.5 (1.3–1.6).
Diabetes: compared with people with no diabetes
Diabetes age-adjusted OR 1.5 (1.3–1.7).
142Case series, CLUE study23,534Need for dialysis or death certificate notification of kidney disease.Gender: compared to men
Women: adjusted HR 0.6 (95% CI 0.4 to 0.8)
Hypertension: compared with SBP <120 mm Hg or DBP <80 mm Hg
Stage 2 hypertension (160–179 mmHg systolic or 100–109 mmHg diastolic) (adjusted HR 5.7, 95% CI 1.7–−18.9)
Stage 3 or 4 hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) (adjusted HR 8.8, 95% CI 2.6–30.3)
Diabetes: compared with no diabetes (identified by medication use) Diabetes: adjusted HR 7.5 (95% CI 4.8–11.7)
Smoking: compared with non current smokers
Current smokers: adjusted HR 2.6 (95% CI 1.8 to 3.7)
154Case series, type 2 diabetics, UKPDS2,167Development of microalbuminuria (UAC 50–299 mg/l)Ethnicity: compared with Caucasians
African Caribbeans: NS (HR 1.21, 95% CI 0.89–1.65, p=0.22)
Indian Asians: HR 2.02 (95% CI 1.59–−2.60), p<0.0001
Smoking: compared with non-smokers
Smokers: HR 1.20 (95% CI 1.01–1.42), p=0.036
Development of macroalbuminuria (UAC ≥300 mg/l)Ethnicity: compared with Caucasians
African Caribbeans: NS (HR 1.05, 95% CI 0.59–1.86, p=0.87)
Indian Asians: HR 2.07 (95% CI 1.36–3.15, p=0.00066).
CrCl ≤60 ml/min/1.73 m2Ethnicity: compared with Caucasians
African Caribbeans: NS (HR 1.26 (95% CI 0.91–1.76, p=0.17) Indian Asians: HR 1.93 (95% CI 1.38–2.72), p=0.00015
Smoking: compared with non-smokers
Smokers: HR 1.25 (95% CI 1.03–1.52), p=0.022

DBP = diastolic blood pressure; Lp = lipoprotein; SBPB = systolic blood pressure; UAC = urinary albumin concentration

From: 5, Classification and early identification

Cover of Chronic Kidney Disease
Chronic Kidney Disease: National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care.
NICE Clinical Guidelines, No. 73.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2008, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.