Chronic kidney disease (CKD) affects nearly 20 million people in the United States and increases risk for cardiovascular disease, end stage renal disease (ESRD) and mortality. Early detection of CKD is critical, as treatment exists to slow the progression of the disease. This project aims to determine whether subclinical albuminuria, beta trace protein (BTP), neutrophil gelatinase associated lipocalin (NGAL), and kidney injury molecule 1 (KIM-1) are associated with incident CKD, ESRD, coronary heart disease (CHD), and death.
The first study examined the association between subclinical levels of albumin excretion, below the current CKD threshold of 30 mg/g, and risk for CHD and death among participants of the Atherosclerosis Risk in Communities (ARIC) study. An additional aim was to assess the effect of gender, race, and diabetes on this association. The results of the study indicate that subclinical levels of urinary albumin excretion are independently associated with CHD and death. The association between subclinically elevated albumin levels and CHD was somewhat stronger in men, blacks, and diabetic participants as compared to their counterparts.
The second study investigated the association between glomerular filtration rate (GFR) estimated using serum creatinine, cystatin C, and BTP and risk for ESRD and death in 866 participants of the African American Study of Hypertension and Kidney Disease (AASK) Trial and Cohort. The results suggest that, although these markers have relatively similar correlations with directly measured GFR, they are differentially associated with ESRD and mortality.
In the third study, the association between NGAL and KIM-1 and incident CKD was determined in a nested case-control study. A total of 143 cases, free of CKD at baseline, were matched on age, sex, and race to 143 controls from the ARIC study and the ARIC Carotid MRI Study. NGAL was associated with incident CKD in the study, while the results showed that KIM-1 might not be the best predictor of CKD.
The results of this dissertation provide additional information that may aid in identifying individuals at risk for CKD and its sequelae earlier, reducing the morbidity, mortality and the costs associated with CKD.