Risk of Incident ESRD: A Comprehensive Look at Cardiovascular Risk Factors and 17 Years of Follow-up in the Atherosclerosis Risk in Communities (ARIC) Study

Background: Diabetes and hypertension are potent risk factors for end-stage renal disease (ESRD). Previous studies suggest that other cardiovascular risk factors also may increase the risk of ESRD; however, risk associated with a comprehensive cardiovascular risk-factor assessment has not been quantified in a population-based sample. Study Design: The Atherosclerosis Risk in Communities (ARIC) Study, a prospective observational cohort. Setting & Participants: 15,324 white and African American participants aged 45-64 years from 4 US communities were followed up after a baseline visit that occurred in 1987-1989. Predictor: A comprehensive collection of cardiovascular risk factors were examined. Outcomes & Measurements: Incidence of ESRD (transplant, dialysis, catheter placement or kidney failure, and death) exclusive of acute kidney failure was ascertained through active surveillance of hospitalizations through 2004. Results: During a median 16-year follow-up, 241 cases of ESRD developed (incidence rate, 1.04 cases/1,000 person-years). Male sex, African American race, diabetes, hypertension, history of coronary heart disease, smoking, older age, body mass index, and triglyceride concentration were associated with increased risk of ESRD after adjustment for baseline estimated glomerular filtration rate (eGFR) and each other. There was a graded curvilinear association between risk of ESRD and lower baseline eGFR at levels < 90 mL/min/1.73 m² and moderately increased levels > 120 mL/min/1.73 m². The relative risk of eGFR on ESRD risk generally was greater in women and individuals with diabetes than in their counterparts. Limitations: Only events occurring in acute-care hospitals were investigated (but there was long-term continuous active surveillance of events). Conclusions: We quantify the relative risk of ESRD in a community-based African American and white population associated with established cardiovascular risk factors (diabetes, hypertension, male sex, and African American race) and report prospective data identifying greater risk of ESRD associated with other cardiovascular risk factors: moderately decreased eGFR, increased eGFR, higher body mass index, smoking, and increased triglyceride level.