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Lipids and cardiovascular/metabolic health

Risk factors for subclinical renal damage and its progression: Hanzhong Adolescent Hypertension Study

European Journal of Clinical Nutrition volume 75, pages 531–538 (2021)Cite this article

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Abstract

Background/Objectives

Chronic kidney disease (CKD) is a global public health problem, including in China. The aim of this study was to identify the risk factors for the development and progression of subclinical renal disease (SRD) in a Chinese population. We also examined whether the impact of the risk factors on SRD changed over time.

Subjects/Methods

To identify the predictors of SRD, we performed a cross-sectional study of the 2432 subjects in our Hanzhong Adolescent Hypertension Cohort. A subgroup of 202 subjects was further analyzed over a 12-year period from 2005 to 2017 to determine the risk factors for the development and progression of SRD.

Results

In cross-sectional analysis, elevated blood pressure, male gender, diabetes, body mass index, and triglyceride were independently associated with a higher risk of SRD. In longitudinal analysis, an increase in total cholesterol over a 4-year period and an increase in serum triglyceride over a 12-year period were independently associated with progression of albuminuria. Finally, increases in both total cholesterol and serum uric acid over a 4-year follow-up showed an independent association with a modest reduction in estimated glomerular filtration rate (eGFR).

Conclusions

In this study of a Chinese cohort, we show several metabolic abnormalities as independent risk factors for subclinical renal disease in a Chinese cohort. In addition, we demonstrate that the effects of total cholesterol, triglycerides and uric acid on the development and progression of albuminuria or the decline in eGFR vary at different points of follow-up. These findings highlight the importance of early detection of metabolic abnormalities to prevent SRD.

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Fig. 1: Flow diagram showing the recruitment of participants in cross-sectional study.

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Acknowledgements

We would particularly like to thank Dr Robert Safirstein (Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA) for language editing. Many thanks to Drs. Rui-Hai Yang and Jun Yang (Institute of Cardiovascular Sciences, Hanzhong People’s Hospital, Hanzhong, China) for providing assistance during follow-up. This work was supported by the National Natural Science Foundation of China No. 81600327 (YW), No. 81870319 (J-JM) and No. 81700368 (CC), Institutional Foundation of the First Affiliated Hospital of Xi’an Jiaotong University No. 2019QN-06, the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China No. XJTU1AF-CRF-2017-021 (YW) and XJTU1AF-CRF-2019-004 (J-JM), Grants from China Postdoctoral Science Foundation funded project (Nos. 2018T111075 and 2018M631177), Special Financial Grant from Shaanxi Postdoctoral Science Foundation (2018BSHTDZZ14), Fundamental Research Funds for the Central Universities (No. xjj2018103), Grants from the Major Chronic Non-communicable Disease Prevention and Control Research Key Project of the Ministry of Science and Technology of China (2017YFC1307604 and 2016YFC1300104), and Grant from Key Laboratory of Molecular Cardiology of First Affiliated Hospital of Xi’an Jiaotong University (KLMC-2018-06).

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Author notes

  1. These authors contributed equally: Yang Wang, Ming-Fei Du, Wei-Hua Gao

Authors and Affiliations

  1. Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Yang Wang, Ming-Fei Du, Bo-Wen Fu, Qiong Ma, Yu Yan, Yue Yuan, Chao Chu, Chen Chen, Yue-Yuan Liao, Ke Gao, Ke-Ke Wang, Min Li, Yue Sun, Dan Wang, Xiao-Yu Zhang, Hao-Wei Zhou, Zu-Yi Yuan & Jian-Jun Mu

  2. Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China

    Yang Wang, Qiong Ma, Yu Yan, Yue Yuan, Chao Chu, Yue-Yuan Liao, Ke-Ke Wang, Zu-Yi Yuan & Jian-Jun Mu

  3. Department of Cardiology, Xi’an NO.1 Hospital, Xi’an, China

    Wei-Hua Gao

  4. Department of Cardiovascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jia-Wen Hu

  5. Department of Dermatology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xin Chen

  6. Department of Stomatology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Qiong Ma

  7. Department of Ophthalmology, Xi’an NO.4 Hospital, Xi’an, China

    Chun-Hua Li

  8. Department of Nephrology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Wan-Hong Lu

  9. Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    John Chang

  10. Department of Medicine, Veterans Administration Healthcare System, West Haven, CT, USA

    John Chang

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  1. Yang Wang
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Contributions

YW and J-JM conceived and designed the experiments; J-JM and Z-YY was responsible for subject recruitment; YW, M-FD, W-HG, B-WF, QM, YY, YY, CC, CC, Y-YL, KG, K-KW, ML, YS, J-WH, QM, DW, H-WZ and performed the experiments; YW, B-WF, XC, X-YZ and C-HL analyzed the data; YW and M-FD drafted manuscript; W-HL, JC and J-JM edited and revised manuscript. All authors read, critically revised and approved the final manuscript.

Corresponding authors

Correspondence to John Chang or Jian-Jun Mu.

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Wang, Y., Du, MF., Gao, WH. et al. Risk factors for subclinical renal damage and its progression: Hanzhong Adolescent Hypertension Study. Eur J Clin Nutr 75, 531–538 (2021). https://doi.org/10.1038/s41430-020-00752-x

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