Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study - PubMed (original) (raw)

Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study

Agus Surachman et al. BMC Nephrol. 2020.

Abstract

Background: There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES.

Methods: The data were from 2118 participants (ages 25-84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA).

Results: A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR < 60 ml/min/1.73 m2 (P = .12; 95%CI = .09-.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = - 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71-0.95]).

Conclusion: These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.

Keywords: Diabetes; Early adversity; Hypertension; Kidney disease; Obesity; Socioeconomic status.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Visual representation of the hypothesis tested in this paper. First, we identified the heterogeneity of comorbidity in risk factors using latent class analysis (LCA). Second, we tested whether different characteristics of comorbidity in risk factors have different impact on kidney function. Third, we examined whether childhood SES, independent of education and adult SES, predicted latent classes of comorbidity in risk factors

Fig. 2

Expected probability with 95% CI for having eGFR < 60 ml/min/1.73 m2 based on classes of CKD risk factors comorbidity; omnibus test: χ2 (4) = 23.66, p < .001; *: significantly higher than the Low Risk class (p < .05; Bonferroni correction applied for multiple comparisons in pairwise comparison tests)

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Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study - PubMed (original) (raw)