Social Isolation Is Associated With Rapid Kidney Function Decline and the Development of Chronic Kidney Diseases in Middle-Aged and Elderly Adults: Findings From the China Health and Retirement Longitudinal Study (CHARLS)

Background: There is limited evidence on the relationship between social isolation and renal outcomes. To address this gap, this study estimated the prospective relationship of social isolation with rapid kidney function decline and the development of chronic kidney disease (CKD) in middle-aged and elderly Chinese with normal kidney function.Methods: We analyzed data from 3,031 participants aged ≥ 45 years with baseline estimated glomerular filtration rates (eGFR) ≥ 60 ml/min/1.73 m2. All data were obtained from the 2011 and 2015 waves of the Chinese Longitudinal Study of Health and Retirement (CHARLS). eGFR was estimated based on a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in renal function, as defined by an eGFR decrease of > 5 ml/min/1.73 m2 per year, while the secondary outcome was the development of CKD, as defined by an eGFR decrease to a level < 60 ml/min/1.73 m2.Results: During the follow-up of 4 years, 258 (8.5%) participants experienced a rapid decline in renal function, while 87 (2.9%) developed CKD. In the fully adjusted model, high social isolation was significantly related to an increased risk of experiencing a rapid decline in renal function (OR 1.805, 95% CI 1.310–2.487) and CKD onset (OR 1.842, 95% CI 1.084–3.129). Among the five components of social isolation, being unmarried, not participating in social activities, and living alone independently predicted declined renal function.Conclusions: Social isolation is significantly associated with the risk of rapid eGFR decline and CKD onset in middle-aged and older adults with normal kidney function in China.

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Anemia and Kidney Function Decline among the Middle-Aged and Elderly in China: A Population-Based National Longitudinal Study

BioMed Research International ◽

10.1155/2020/2303541 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Chao Yang ◽

Qinqin Meng ◽

Huaiyu Wang ◽

Yafeng Wang ◽

Zaiming Su ◽

...

Keyword(s):

Longitudinal Study ◽

General Population ◽

Kidney Function ◽

Cubic Splines ◽

World Health ◽

Rapid Decline ◽

Middle Aged ◽

Public Health Burden ◽

Restricted Cubic Splines ◽

Kidney Function Decline

Chronic kidney disease (CKD) is a public health burden, and anemia is common among patients with CKD. However, less is known regarding the longitudinal association between anemia and deterioration of kidney function among the general population. The China Health and Retirement Longitudinal Study is a nationally representative survey for households with members aged ≥ 45 years. Participants without creatinine and demographic data in 2011 and 2015 were excluded. Anemia was defined according to definitions of the World Health Organization. Rapid decline in kidney function was defined as a ≥16.9% (quartile 3) decline in estimated glomerular filtration rate (eGFR), calculated using the CKD-EPI equation during 2011-2015. Multivariate logistic regression and restricted cubic splines were used to explore their relationship. Altogether, 7210 eligible participants were included in the analysis, with a mean age of 58.6 ± 8.8 years. Rapid decline in kidney function occurred among 1802 (25.0%) participants. Those with kidney function decline were more likely to be older, male, and have anemia, lower eGFRs, hypertension, and cardiovascular disease ( P < 0.05 ). Anemia, or hemoglobin, was independently associated with rapid decline in kidney function after adjusting for potential confounding factors ( OR = 1.64 , 95% CI, 1.32-2.04; OR = 0.90 , 95% CI, 0.87-0.94, respectively). Restricted cubic splines showed a nonlinear relationship between hemoglobin and rapid decline in kidney function, especially for men with anemia ( P < 0.05 ). In conclusion, anemia is an independent risk factor for progression of kidney function among the middle-aged and elderly population. Attentive management and intervention strategies targeting anemia could be effective to reduce the risk of kidney failure and improve the prognosis of the general population.

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Risk factors for renal function decline in adults with normal kidney function: a 7-year cohort study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2014-204962 ◽

2015 ◽

Vol 69 (8) ◽

pp. 782-788 ◽

Cited By ~ 11

Author(s):

Xianhui Qin ◽

Yuejuan Wang ◽

Youbao Li ◽

Di Xie ◽

Genfu Tang ◽

...

Keyword(s):

Risk Factors ◽

Renal Function ◽

Cohort Study ◽

Kidney Function ◽

Normal Kidney ◽

Renal Function Decline ◽

Normal Kidney Function

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Abstract 215: Adam17 Regulates Renal Function

Circulation ◽

10.1161/circ.142.suppl_4.215 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Bo Zhang ◽

Kai Chen ◽

Zhongjie Sun

Keyword(s):

Renal Function ◽

Kidney Function ◽

Renal Tubule ◽

Renal Diseases ◽

Normal Kidney ◽

Normal Kidney Function ◽

Membrane Bound ◽

Tubule Cells ◽

A Disintegrin And Metalloproteinase

A disintegrin and metalloproteinase 17 (ADAM17) is a ubiquitously expressed membrane-bound sheddase that cleaves a diverse variety of membrane-bound molecules, including cytokines, growth factors, and their receptors to activate or inactivate various cellular signaling pathways. Although it was reported that ADAM17 may mediate renal diseases, the role of ADAM17 in the regulation of normal kidney function has never been identified. The objective of this study is to investigate whether renal ADAM17 plays a role in maintaining normal kidney function and structure. Tamoxifen-inducible kidney-specific cre (Ksp) and ADAM17-floxed mice were cross-bred for generating Ksp/ADAM17-floxed mice. Injection of tamoxifen initiated deletion of the ADAM17 gene in renal tubule cells. We found that conditional kidney-specific knockout of ADAM1 7 gene (Ksp-ADAM17 -/-) decreased urinary creatinine and sodium excretion were decreased in Ksp-ADAM17 -/- mice, indicating that ADAM17 gene deficiency impairs kidney function. H&E staining showed glomerulus collapse and tubule dilation in Ksp-ADAM17 -/- mice. The epithelial cells fall off into the lumen in the renal tubule. Mesangial expansion and fibrosis were found in glomeruli in Ksp-ADAM17 -/- mice. Moreover, apoptosis was increased in tubule cells in both cortex and medulla areas in Ksp-ADAM17 -/- mice. In conclusion, ADAM17 is critical to the maintenance of normal renal function and structure.

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Dietary Protein, Kidney Function and Mortality: Review of the Evidence from Epidemiological Studies

Nutrients ◽

10.3390/nu11010196 ◽

2019 ◽

Vol 11 (1) ◽

pp. 196 ◽

Cited By ~ 8

Author(s):

Giancarlo Bilancio ◽

Pierpaolo Cavallo ◽

Carolina Ciacci ◽

Massimo Cirillo

Keyword(s):

Kidney Function ◽

Protein Intake ◽

Substantial Reduction ◽

Epidemiological Studies ◽

World Health ◽

Normal Kidney ◽

Ideal Weight ◽

Normal Kidney Function ◽

Kidney Function Decline

The World Health Organization recommends a minimum requirement of 0.8 g/day protein/kg ideal weight. Low protein diets are used against kidney failure progression. Efficacy and safety of these diets are uncertain. This paper reviews epidemiological studies about associations of protein intake with kidney function decline and mortality. Three studies investigated these associations; two reported data on mortality. Protein intake averaged >60 g/day and 1.2 g/day/kg ideal weight. An association of baseline protein intake with long-term kidney function decline was absent in the general population and/or persons with normal kidney function but was significantly positive in persons with below-normal kidney function. Independent of kidney function and other confounders, a J-curve relationship was found between baseline protein intake and mortality due to ≈35% mortality excess for non-cardiovascular disease in the lowest quintile of protein intake, a quintile where protein intake averaged <0.8 g/day/kg ideal weight. Altogether, epidemiological evidence suggests that, in patients with reduced kidney function, protein intakes of ≈0.8 g/d/kg ideal weight could limit kidney function decline without adding non-renal risks. Long-term lower protein intake could increase mortality. In most patients, an intake of ≈0.8 g/day/kg would represent a substantial reduction of habitual intake considering that average intake is largely higher.

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Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2015.06.024 ◽

2016 ◽

Vol 67 (2) ◽

pp. 227-234 ◽

Cited By ~ 9

Author(s):

Nisha Bansal ◽

Feng Lin ◽

Eric Vittinghoff ◽

Carmen Peralta ◽

Joao Lima ◽

...

Keyword(s):

Young Adults ◽

Coronary Artery ◽

Left Ventricular Mass ◽

Kidney Function ◽

Left Ventricular ◽

Normal Kidney ◽

Middle Aged ◽

Estimated Gfr ◽

Normal Kidney Function ◽

Middle Aged Adults

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Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in a Patient with Normal Renal Function

Case Reports in Emergency Medicine ◽

10.1155/2012/815907 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

L. Connor Nickels ◽

Christine Jones ◽

Latha Ganti Stead

Keyword(s):

Renal Function ◽

Adverse Effects ◽

Renal Insufficiency ◽

Kidney Function ◽

Normal Renal Function ◽

Normal Kidney ◽

Medical Field ◽

Normal Kidney Function ◽

Life Threatening

The authors present a case of Trimethoprim-sulfamethoxazole-induced hyperkalemia in a patient with normal renal function. While toxicity of this drug has been reported in patients with renal insufficiency, this case highlights the toxicity associated with normal kidney function. Due to its popularity in the medical field and to the largely unrecognized effect of hyperkalemia, it is important to consider such adverse effects when prescribing TMX-SMX. One must be reminded of the possibility of the development of life-threatening hyperkalemia in relatively healthy patients.

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Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.18441120 ◽

2021 ◽

pp. CJN.18441120

Author(s):

Zhuxian Zhang ◽

Panpan He ◽

Mengyi Liu ◽

Chun Zhou ◽

Chengzhang Liu ◽

...

Keyword(s):

Depressive Symptoms ◽

Confidence Interval ◽

Kidney Function ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Depression Scale ◽

Epidemiologic Studies ◽

Rapid Decline ◽

Normal Kidney ◽

Normal Kidney Function

Background and objectivesThe relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function.Design, setting, participants, & measurementsA total of 4763 participants with eGFR≥60 ml/min per 1.73 m2 at baseline were enrolled from the China Health and Retirement Longitudinal Study. Baseline depressive symptoms were determined using a ten-item Center for Epidemiologic Studies Depression scale with a cutoff score of greater than or equal to ten to define high depressive symptoms. The GFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in kidney function, defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2. Secondary outcome was defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2 and to a level of <60 ml/min per 1.73 m2 at the exit visit.ResultsDuring a median follow-up of 4 years (interquartile range, 3.92–4.00), 260 (6%) participants developed rapid decline in kidney function. Overall, there was a significant positive association between baseline depressive symptoms and rapid decline in kidney function (per five-scores increment; adjusted odds ratio, 1.15; 95% confidence interval, 1.03 to 1.28) after adjustments for major demographic, clinical, or psychosocial covariates. Consistently, compared with participants with low depressive symptoms (total Center for Epidemiologic Studies Depression scale score less than ten), a significantly higher risk of rapid decline in kidney function was found among those with high depressive symptoms (total Center for Epidemiologic Studies Depression scale score greater than or equal to ten; adjusted odds ratio, 1.39; 95% confidence interval, 1.03 to 1.88). Similar results were found for the secondary outcome (per five-scores increment; adjusted odds ratio, 1.26; 95% confidence interval, 1.06 to 1.51).ConclusionsHigh depressive symptoms were significantly associated with a higher risk of rapid kidney function decline among Chinese adults with normal kidney function.

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