Nontraditional Risk Factors for Progression Through Chronic Kidney Disease Risk Categories: The Coronary Artery Risk Development in Young Adults Study

Yuni Choi, David R. Jacobs, Holly J. Kramer, Gautam R. Shroff, Alexander R. Chang, Daniel A. Duprez

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: There may be nontraditional pathways of chronic kidney disease (CKD) progression that are complementary to classical pathways. Therefore, we aimed to examine nontraditional risk factors for incident CKD and its progression. Methods: We used the generally healthy population (n = 4382) starting at age 27-41 years in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, which is an observational longitudinal study. Nontraditional risk factors included forced vital capacity, inflammation, serum urate, and serum carotenoids. CKD risk category was classified using the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) measured in 1995-1996 and repeated every 5 years for 20 years: No CKD, low risk, moderate risk, high risk, and very high risk. Results: At baseline, 84.8% had no CKD (eGFR ≥60 mL/min/1.73 m2 and UACR <10 mg/g), 10.3% were in the low risk (eGFR ≥60 and UACR 10-29), and 4.9% had CKD (eGFR <60 and/or UACR ≥ 30). Nontraditional risk factors were significantly associated with the progression of CKD to higher categories. Hazard ratios per standard deviation of the predictor for incident CKD and its progression from the No CKD and low and moderate risk into CKD were inverse for forced vital capacity and serum carotenoids and positive for serum urate, GlycA, and C-reactive protein, the first 3 even after adjustment for conventional risk factors. Conclusion: Several nontraditional markers were significantly associated with an increased risk of progression to higher CKD categories in generally healthy young to middle-aged adults.

Original languageEnglish (US)
Pages (from-to)380-389.e10
JournalAmerican Journal of Medicine
Issue number4
StatePublished - Apr 2023

Bibliographical note

Funding Information:
Funding: The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This manuscript has been reviewed by CARDIA for scientific content. The sponsor, NHLBI has a representative on the Steering Committee of CARDIA and participated in study design, data collection, and scientific review of this paper. The sponsor had no role in data analysis, data interpretation, or writing of this report. The data used in this study are available from the CARDIA Coordinating Center ( ) on reasonable request.

Publisher Copyright:
© 2022 Elsevier Inc.


  • Antioxidant marker
  • Chronic kidney disease progression
  • Inflammatory marker
  • Longitudinal study
  • Lung function marker
  • Serum urate

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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