What are the risk factors for Chronic Kidney Disease (CKD)?

Risk Factors for Chronic Kidney Disease

Diabetes and hypertension are the two dominant risk factors for CKD, together accounting for the majority of cases in developed countries, with diabetes alone responsible for 30-40% of end-stage kidney disease. 1, 2, 3

Primary Risk Factors

Diabetes Mellitus

• Diabetic kidney disease is the single leading cause of CKD and end-stage kidney disease in the United States, accounting for more than 30-40% of cases in many countries 2, 3
• Type 1 diabetes: CKD typically develops after 10 years of disease duration 2
• Type 2 diabetes: CKD may already be present at the time of diagnosis—studies show 6.5% of newly diagnosed type 2 diabetics already have urinary albumin >50 mg/L 2
• Diabetic patients have approximately 50% higher risk of progressing to end-stage renal disease compared to patients with similar GFR from other causes 3
• In uncontrolled type 2 diabetes, 20-40% will develop microalbuminuria within 10-15 years, with 80-90% of those progressing to more advanced stages 2

Hypertension

• Hypertension is one of the most frequent causes of CKD in developed countries and creates a dangerous bidirectional relationship: it both causes kidney damage AND results from kidney disease, creating a cycle that accelerates kidney function decline 2, 3
• Uncontrolled hypertension dramatically accelerates CKD progression, with GFR decreasing at rates >10 mL/min/year in patients with poorly controlled hypertension and macroalbuminuria 2, 3
• Medicare data shows 91% of CKD patients have hypertension 1

Demographic and Genetic Risk Factors

Age

• Older age (>60 years) is a well-established risk factor for CKD development 1
• The prevalence of CKD increases substantially with advancing age 4

Race and Ethnicity

• African Americans are 3 to 5 times more likely to develop end-stage renal disease than white Americans, despite similar overall CKD prevalence (11.2% vs 11.6%) 1
• U.S. racial and ethnic minorities should be considered at increased risk and undergo testing 1
• Being of African-American descent is considered a strong risk factor for CKD 4

Family History

• Family history of chronic kidney disease is a significant risk factor 1
• Family history of diabetic kidney disease, hypertension, or cardiovascular disease increases risk 3

Gender

• CKD is more prevalent in women (12.6%) than in men (9.7%) 1
• Male gender is considered a traditional risk factor 5

Cardiovascular and Metabolic Risk Factors

Cardiovascular Disease

• Cardiovascular disease is a well-established risk factor for CKD development 1
• Medicare data shows 46% of CKD patients have atherosclerotic heart disease 1
• History of cardiovascular disease constitutes a risk factor for CKD 4

Obesity

• Obesity is a well-established risk factor for CKD 1, 4
• Obesity contributes to the development and progression of kidney disease 4

Dyslipidemia and Metabolic Syndrome

• Hyperlipidemia is a risk factor for chronic kidney disease 4
• Metabolic syndrome increases risk for CKD development 4

Lifestyle and Environmental Risk Factors

Smoking

• Tobacco use is a traditional and mutual risk factor between CKD and cardiovascular disease 5
• Smoking is a modifiable risk factor that can lead to kidney disease 4

Nephrotoxic Exposures

• Exposure to heavy metals constitutes a risk for CKD 4
• Excessive alcohol consumption increases risk 4
• Use of analgesic medications, particularly NSAIDs, poses risk 4
• The "triple whammy" combination of ACE inhibitors/ARBs, diuretics, and NSAIDs should be avoided, especially in elderly patients 3

Other Medical Conditions

Glomerulonephritis

• Glomerulonephritis is a significant cause of CKD, particularly in certain Asian regions and sub-Saharan Africa 3
• In China, chronic glomerulonephritis and diabetes together account for more than 50% of CKD cases 2, 3

Acute Kidney Injury

• History of acute kidney injury is a risk factor for developing chronic kidney disease 4

Infectious Diseases

• Hepatitis C virus infection increases CKD risk 4
• HIV infection is a risk factor for kidney disease 4

Malignancy

• History of malignancy constitutes a risk factor for CKD 4

Low Birth Weight

• Low birth weight is considered a strong risk factor for chronic kidney disease 4

Clinical Implications for Screening

All persons should be assessed during routine health encounters to determine if they are at increased risk for CKD based on clinical and sociodemographic factors. 1

Who Should Be Screened

• Patients with diabetes should be screened immediately at diagnosis (type 2) or after 5 years (type 1) using urinary albumin-to-creatinine ratio and estimated GFR 2, 3
• Patients with hypertension require regular kidney function monitoring 3
• Persons with family history of CKD should undergo testing 1
• Persons older than 60 years should be tested 1
• U.S. racial and ethnic minorities should undergo testing 1

Screening Tests

• Urinary albumin-to-creatinine ratio (UACR) in a random spot urine collection 2
• Estimated glomerular filtration rate (eGFR) calculated from serum creatinine 1
• Persistent albuminuria (≥30 mg/g) for at least 3 months indicates chronic kidney damage 3
• eGFR <60 mL/min/1.73 m² for at least 3 months confirms CKD 2

Common Pitfalls to Avoid

• Never assume normal-sized kidneys on imaging exclude CKD—diabetic kidney disease, minimal change disease, and early focal segmental glomerulosclerosis all present with normal kidney size despite significant dysfunction 2, 3
• Do not wait to screen type 2 diabetics—CKD may already be present at diagnosis 2
• Avoid the nephrotoxic "triple whammy" drug combination in at-risk patients 3
• Do not rely on serum creatinine alone—it is less sensitive than eGFR for detecting early CKD 6