Kidney Week

Abstract: TH-PO424

Incident CKD over 4 Years in a Population-Based Study of Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy (MeN)

Session Information

• CKD: Risk Scores and Translational Epidemiology
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gonzalez, Marvin Antonio, UCL, London, United Kingdom

Marvin Antonio Gonzalez,

• Camacho, Armando Benito, Research Center on Health, Work and Environment at National Autonomous University of Nicaragua, Leon, León, Nicaragua

Armando Benito Camacho,

• Nitsch, Dorothea, London School of Hygiene and Tropical Medicine, London, United Kingdom

Dorothea Nitsch,

• Pearce, Neil, London School of Hygiene and Tropical Medicine, London, United Kingdom

Neil Pearce,

• Caplin, Ben, UCL, London, United Kingdom

Ben Caplin,

Background

MeN has led to the death of tens of thousands of young adults across rural Central America. We recently reported eGFR decline of over 30mL/min/1.7m² over 2 years among substantial numbers of apparently healthy young adults from rural communities in northwest Nicaragua¹. The consequences of this early loss of eGFR is not known.

Methods

The original 350 participants (a rural, population-based sample, aged 18-30 years, male:female ratio 3:1, without reported diabetes, hypertension or CKD) from the study have been followed-up annually for a further 2 years. An additional 417 men and women (ratio 1:1) were recruited in October 2018. Serum creatinine was measured at UNAN-León after each study visit and eGFR was calculated by CKD-EPI formula. de novo CKD was defined as those participants from the original cohort with an eGFR≥60mL/min/1.7m² at baseline who developed an eGFR <60mL/min/1.7m² on at least two serial measurements without recovery.

Results

Across all participants (mean age 24.8 years) at baseline 87% of men and 95% of women had an eGFR≥90mL/min/1.7m2, but despite excluding those self-reporting CKD, 2.9% of males had an eGFR<60mL/min/1.7m².

In the original cohort, 90% participants attended ≥2 of the 7 study visits. eGFR varied substantially visit-to-visit such that 42% of men (Figure) and 54% of women had an eGFR<90mL/min/1.7m² at some point during the 4-year follow-up. Furthermore, among men (but not women), 11% had an eGFR<60mL/min/1.7m² (at ≥1 visit), 3.8% developed de novo CKD, and 0.8% (n=2) died from kidney failure over the follow-up.

Conclusion

Within person eGFR varies substantially in this population at high-risk of MeN. This likely reflects important biological effects, as well as analytical variation, making longitudinal studies critical for disease insight. Nonetheless there is both a substantial loss of eGFR and unprecedented rates of incident CKD among young men in the region.

1. Gonzalez-Quiroz et al. JASN 2018

Local eGFR measurements over the study period in men

Funding

• Private Foundation Support