Abstract: TH-OR052
Brain-Kidney Axis: Risk of Incident CKD After Traumatic Brain Injury
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
- Stewart, Ian J., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Amuan, Megan, University of Utah Health, Salt Lake City, Utah, United States
- Howard, Jeffrey T., The University of Texas at San Antonio, San Antonio, Texas, United States
- Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Pugh, Mary Jo, University of Utah Health, Salt Lake City, Utah, United States
Background
Traumatic brain injury (TBI) triggers a neuroinflammatory response and disrupts autonomic regulation, mechanisms that may contribute to development of chronic kidney disease (CKD) via the brain-kidney axis.
In this analysis, we evaluated the incidence of CKD in participants by varying severity of TBI using the Trauma Registry and Long-term Impact of Military Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) cohort.
Methods
Using a Fine-Gray competing risk model, we evaluated the association between TBI severity and incident CKD, treating acute kidney injury (AKI) as a time-varying exposure. Inverse probability weighting (IPW) was applied to account for differences in baseline characteristics across TBI severity groups. The proportional hazards assumption was assessed, and due to evidence of nonproportionality, time-specific hazard estimates were calculated.
Results
Out of a total of 1844966 veterans with at least two years of lab data and without CKD at baseline, there were 87597 incident cases of CKD. We categorized TBI as none (n=1456946), mild (n=288545), moderate-to-severe (n=56403), penetrating (n=23842) or unclassified (n=19230). Those with more severe TBI were more likely to also have an AKI diagnosis within the first year of follow-up (mild, odds ratio [OR] 1.84, 95% CI 1.79-1.88; moderate-to-severe, OR 2.01, 95% CI 1.93-2.10; penetrating, OR 2.65, 95% CI 2.51-2.79; unclassified, OR 1.49, 95% CI 1.38-1.61), compared to those without TBI. After adjustment for AKI and covariates, time-averaged estimates showed that moderate-to-severe TBI was associated with the highest hazard of incident CKD, followed by penetrating and unclassified TBI (Table 1). At 10 years of follow-up, veterans with moderate-to-severe TBI had a 16% higher risk of CKD compared to those without TBI after adjustment.
Conclusion
Moderate-to-severe, penetrating, and unclassified TBI were associated with an increased risk of incident CKD. The elevated risk remained significant after adjusting for AKI, suggesting additional underlying mechanisms.
Acknowledgment
This study was supported by the U.S. Army Medical Research Acquisition Activity through grant #W81XWH-13-2-0095, VA Rehabilitation Research and Development Service Award I01RX003443, and Health Systems Research Service Research Career Scientist Award, 11IK6HX003762 RCS 17-297.
TBI severity and risk of incident CKD
| TBI Severity | Subdistribution Hazard Ratio | 95% Confidence Interval |
| Mild | 1.00 | 0.99, 1.01 |
| Moderate-to-severe | 1.08 | 1.07, 1.09 |
| Penetrating | 1.07 | 1.06, 1.08 |
| Unclassified | 1.04 | 1.03, 1.05 |
Funding
- Veterans Affairs Support