From the Guidelines
The primary causes of End-Stage Renal Disease (ESRD) in young adults are chronic glomerular disease, diabetic kidney disease, and obesity-related kidney disease.
Causes of ESRD in Young Adults
- Chronic glomerular disease: This is a leading cause of acquired kidney disease leading to ESRD in children and young adults, with Focal Segmental Glomerulosclerosis (FSGS) being a common cause 1.
- Diabetic kidney disease: This is a significant cause of ESRD in young adults, particularly those with a history of diabetes and obesity 1.
- Obesity-related kidney disease: The increasing prevalence of obesity in young adults has contributed to the rising incidence of ESRD, with obesity-related kidney disease becoming a significant cause of ESRD in this population 1.
Risk Factors
- Hypertension: Uncontrolled hypertension is a significant risk factor for the progression of kidney disease to ESRD 1.
- Dyslipidemia: Abnormal lipid profiles are common in patients with CKD and may contribute to the progression of kidney disease 1.
- Proteinuria: The presence of proteinuria is a significant risk factor for the progression of kidney disease to ESRD 1. The life expectancy of young adults with ESRD is significantly reduced, with a median life expectancy of approximately 30 years after diagnosis 1. Therefore, it is essential to identify and manage the underlying causes of ESRD in young adults to slow disease progression and improve outcomes.
From the Research
Causes of End-Stage Renal Disease (ESRD) in Young Adults
- Diabetes is a leading cause of ESRD, accounting for 36% of incident cases in 1992 in the United States 2
- Hypertension and glomerulonephritis are also common causes of ESRD 2
- Other potential causes of ESRD include renovascular disease and analgesic ingestion, which may be underreported 2
- Childhood risk factors, such as hypertension and elevated body mass index, can increase the risk of developing ESRD in young adulthood 3
- A history of childhood kidney disease, including congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease, is associated with a significantly increased risk of ESRD in adulthood 4
Risk Factors for ESRD in Young Adults
- Lack of preemptive transplant compared with hemodialysis or peritoneal dialysis is associated with higher risks for CV hospitalization and mortality 5
- Nephrology care before ESRD is associated with lower risk for CV mortality 5
- Elevated blood pressure and body mass index in childhood are associated with an increased risk of ESRD in young adulthood 3
- A history of kidney disease in childhood is associated with younger age at the onset of ESRD 4
Cardiovascular Disease and ESRD
- Cardiovascular disease is a leading cause of death among patients with ESRD, accounting for nearly 40% of deaths in young adults with incident ESRD 5
- Left ventricular hypertrophy, aortic valve calcification, and increased arterial stiffness are common alterations in young adult survivors with childhood ESRD 6
- Chronic pressure and volume overload, a high calcium-phosphate product, and chronic inflammation contribute to the development of cardiovascular disease in children and young adults with ESRD 6