Chronic kidney disease and the risk of incident hearing loss.
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ABSTRACT: Objectives
There is a strikingly high prevalence of sensorineural hearing loss among patients with chronic kidney disease, with estimates ranging from 36% to 77%; however, longitudinal data are limited. We assessed whether lower baseline estimated glomerular filtration rate calculated using creatinine (eGFRCr ), as well as decline in eGFRCr over time, were associated with incident hearing loss.Methods
Serum creatinine was measured in 1,843 individuals aged 48 to 80 years without hearing loss at the start of the Epidemiology of Hearing Loss Study in 1993. Follow-up creatinine assessments were conducted at 5 (n = 1,526) and 10 (n = 1,095) years. Hearing tests were conducted at baseline and at 5-, 10-, and 15-year follow-up visits. The risk of hearing loss was assessed as a function of baseline eGFRCr as well as a function of a 20% decline in eGFRCr between baseline and 5 years and between 5 and 10 years. Cox proportional hazards regression was used to examine the risk of incident speech-frequency hearing loss, defined as pure tone average (PTA) > 25 decibels hearing loss for thresholds at 0.5, 1, 2, and 4 kHz (PTA0.5,1,2,4 ) in either ear.Results
During 15,676 person-years of follow up, there were 802 cases of incident hearing loss. There was no statistically significant association between lower baseline eGFRCr and risk of incident hearing loss. Decline in eGFRCr was also not associated with incident hearing loss at speech frequencies.Conclusion
Overall, there was no significant association between eGFRCr or decline in eGFRCr using the serum creatinine-based equation and risk of incident hearing loss.Level of evidence
2 Laryngoscope, 130:E213-E219, 2020.
SUBMITTER: Gupta S
PROVIDER: S-EPMC6881518 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceEarly identification of individuals at elevated risk of developing chronic kidney disease (CKD) could improve clinical care through enhanced surveillance and better management of underlying health conditions.ObjectiveTo develop assessment tools to identify individuals at increased risk of CKD, defined by reduced estimated glomerular filtration rate (eGFR).Design, setting, and participantsIndividual-level data analysis of 34 multinational cohorts from the CKD Prognosis Consortium including 5 222 711 individuals from 28 countries. Data were collected from April 1970 through January 2017. A 2-stage analysis was performed, with each study first analyzed individually and summarized overall using a weighted average. Because clinical variables were often differentially available by diabetes status, models were developed separately for participants with diabetes and without diabetes. Discrimination and calibration were also tested in 9 external cohorts (n = 2 253 540).ExposuresDemographic and clinical factors.Main outcomes and measuresIncident eGFR of less than 60 mL/min/1.73 m2.ResultsAmong 4 441 084 participants without diabetes (mean age, 54 years, 38% women), 660 856 incident cases (14.9%) of reduced eGFR occurred during a mean follow-up of 4.2 years. Of 781 627 participants with diabetes (mean age, 62 years, 13% women), 313 646 incident cases (40%) occurred during a mean follow-up of 3.9 years. Equations for the 5-year risk of reduced eGFR included age, sex, race/ethnicity, eGFR, history of cardiovascular disease, ever smoker, hypertension, body mass index, and albuminuria concentration. For participants with diabetes, the models also included diabetes medications, hemoglobin A1c, and the interaction between the 2. The risk equations had a median C statistic for the 5-year predicted probability of 0.845 (interquartile range [IQR], 0.789-0.890) in the cohorts without diabetes and 0.801 (IQR, 0.750-0.819) in the cohorts with diabetes. Calibration analysis showed that 9 of 13 study populations (69%) had a slope of observed to predicted risk between 0.80 and 1.25. Discrimination was similar in 18 study populations in 9 external validation cohorts; calibration showed that 16 of 18 (89%) had a slope of observed to predicted risk between 0.80 and 1.25.Conclusions and relevanceEquations for predicting risk of incident chronic kidney disease developed from more than 5 million individuals from 34 multinational cohorts demonstrated high discrimination and variable calibration in diverse populations. Further study is needed to determine whether use of these equations to identify individuals at risk of developing chronic kidney disease will improve clinical care and patient outcomes.
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Project description:BACKGROUND:Growth differentiation factor-15 (GDF-15), soluble ST2 (sST2), and high-sensitivity troponin I (hsTnI) are emerging predictors of adverse clinical outcomes. We examined whether circulating concentrations are related to the development of kidney disease in the community. METHODS:Plasma GDF-15, sST2, and hsTnI concentrations were measured in 2614 Framingham Offspring cohort participants (mean age 57 years, 54% women) at the sixth examination cycle (1995-1998). Associations of biomarkers with incident chronic kidney disease [CKD, eGFR <60 mL · min(-1) · (1.73 m(2)) (-1), n = 276], microalbuminuria (urinary albumin to creatinine ratio ?25 mg/g in women and 17 mg/g in men, n = 191), and rapid decline in renal function [decline in eGFR ?3 mL · min(-1) · (1.73 m(2)) (-1) per year, n = 237], were evaluated using multivariable logistic regression; P < 0.006 was considered statistically significant in primary analyses. RESULTS:Participants were followed over a mean of 9.5 years. Higher plasma GDF-15 was associated with incident CKD [multivariable-adjusted odds ratio (OR) 1.9 per 1-U increase in log-GDF-15, 95% CI 1.6-2.3, P < 0.0001] and rapid decline in renal function (OR, 1.6; 95% CI, 1.3-1.8; P < 0.0001). GDF-15, sST2, and hsTnI had suggestive associations with incident microalbuminuria but did not meet the prespecified P-value threshold after multivariable adjustment. Adding plasma GDF-15 to clinical covariates improved risk prediction of incident CKD: the c-statistic increased from 0.826 to 0.845 (P = 0.0007), and categorical net reclassification was 6.3% (95% CI, 2.7-9.9%). CONCLUSIONS:Higher circulating GDF-15 is associated with incident renal outcomes and improves risk prediction of incident CKD. These findings may provide insights into the mechanisms of renal injury.
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