Kidney Week

Abstract: TH-OR40

Kidney Volume and Risk of Incident CKD

Session Information

• CKD: Novel Risk Factors and Consequences
  October 24, 2024 | Location: Room 24, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Wu, Jianhan, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Jianhan Wu, MS, MSc

• Wang, Yifan, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada

Yifan Wang

• Vlasschaert, Caitlyn, Queen's University, Kingston, Ontario, Canada

Caitlyn Vlasschaert, MD, MS, PhD

• Lali, Ricky, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Ricky Lali, MS, MSc

• Feiner, James, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

James Feiner, MSc

• Gaheer, Pukhraj Singh, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Pukhraj Singh Gaheer

• Yang, Serena, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Serena Yang

• Perrot, Nicolas, Population Health Research Institute, Hamilton, Ontario, Canada

Nicolas Perrot, PhD

• Chong, Michael R., Population Health Research Institute, Hamilton, Ontario, Canada

Michael R. Chong, MSc, PhD

• Pare, Guillaume, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Guillaume Pare

• Lanktree, Matthew Bruce, St. Joseph Health Care Hamilton, Hamilton, Ontario, Canada

Matthew Bruce Lanktree, MD, PhD, FASN

Background

Low total kidney volume (TKV) is a risk factor for CKD. However, evaluations of causal inference and prognostic utility beyond traditional biomarkers are lacking.

Methods

TKV of 34,595 White British ancestry participants were derived from the UK Biobank. Association with incident CKD were assessed with Cox proportional hazard models. Prognostic thresholds for CKD risk stratification were identified using a modified Mazumdar method with bootstrap resampling. Overall improvement in model performance was assessed using likelihood ratio test. Risk reclassification was evaluated with 5-fold cross-validation. Bidirectional associations of genetically predicted TKV with kidney traits were assessed using two-sample Mendelian randomization (MR).

Results

Adjusted for eGFR and albuminuria, a lower TKV of 10 mL was associated with a 6% higher risk of incident CKD (HR 1.06, 95% CI 1.03 to 1.08, P = 5.8 x 10^-6). Individuals below the prognostic threshold of body surface area adjusted TKV (BSA-TKV) at 119 mL/m² (10^th percentile) exhibited 2.8-fold (95% CI 2.03 to 3.85, P = 2.9 x 10^-10) higher risk of incident CKD after accounting for eGFR, albuminuria, and traditional risk factors. Addition of BSA-TKV improved model performance of the CKD Prognosis Consortium Incident CKD Risk Score (likelihood ratio P = 4.8 x 10^-14) and improved reclassification of high-risk prognostication at a rate of 1 per 3.3 cases (95% CI 3.1 to 3.6). In MR, a lower genetically predicted TKV by 10 mL was associated with 10% higher CKD risk (OR 1.10, 95% CI 1.06 to 1.14, P = 1.3 x 10^-7). Reciprocally, an elevated risk of genetically predicted CKD by 2-fold was associated with a lower TKV by 7.88 mL (95% CI -9.81 to -5.95, P = 1.2 x 10^-15).

Conclusion

Kidney volume was associated with incident CKD independent of traditional risk factors including baseline eGFR and albuminuria. Mendelian randomization demonstrated a bidirectional relationship between kidney volume and CKD.

Funding

• Government Support – Non-U.S.