{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:19:03Z","timestamp":1782537543427,"version":"3.54.5"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Previous studies of worsening chronic kidney disease (CKD) based on declining estimated glomerular filtration rate (eGFR) or increasing urine albumin\u2010creatinine ratio (UACR) are limited to later middle\u2010age and older adults. We examined associations of CKD progression and incident cardiovascular disease (CVD) and mortality in younger adults.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We studied 4382 adults in CARDIA (Coronary Artery Risk Development in Young Adults) initially aged 27 to 41\u2009years and prospectively over 20\u2009years. Five\u2010year transition probabilities across CKD risk categories were based on eGFR and UACR measured at each exam. Proportional hazards models predicted incident CVD and all\u2010cause mortality by time\u2010varying CKD risk category, adjusting for demographics and CVD risk factors. Progression of CKD risk categories over 20\u2009years occurred in 28.7% (1256\/4382) of participants, driven by increases in UACR, but including 5.8% (n=255) with eGFR&lt;60 mL\/min per 1.73\u2009m\n              <jats:sup>2<\/jats:sup>\n              or UACR \u2265300 mg\/g. Compared with eGFR \u226560 and UACR &lt;10, demographic and smoking\u2010adjusted hazard ratios for CVD were 1.62 (95% CI, 1.21\u20132.18) for low CKD risk (eGFR \u226560 with UACR 10\u201329) and 13.65 (95% CI, 7.52\u201324.79) for very high CKD risk (eGFR &lt;30 or eGFR 30\u201344 with UACR 30\u2013299; or eGFR 30\u201359 with UACR \u2265300). Corresponding hazard ratios for all\u2010cause mortality were 1.42 (95% CI, 1.08\u20131.88) and 14.75 (95% CI, 9.97\u201321.82). Although CVD associations were attenuated after adjustment for mediating CVD risk factors, all\u2010cause mortality associations remained statistically significant.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Among young to middle\u2010aged adults, progression to higher CKD risk category was common. Routine monitoring eGFR and UACR holds promise for prevention of CVD and total mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026685","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T10:48:09Z","timestamp":1667213289000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Progression of Chronic Kidney Disease Risk Categories and Risk of Cardiovascular Disease and Total Mortality: Coronary Artery Risk Development in Young Adults Cohort"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-5331","authenticated-orcid":false,"given":"Yuni","family":"Choi","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7232-0543","authenticated-orcid":false,"suffix":"Jr","given":"David R.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7614-9560","authenticated-orcid":false,"given":"Gautam R.","family":"Shroff","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Department of Medicine, Hennepin Healthcare University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6374-837X","authenticated-orcid":false,"given":"Holly","family":"Kramer","sequence":"additional","affiliation":[{"name":"Departments of Public Health Sciences and Medicine Loyola University Chicago Maywood IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8114-7447","authenticated-orcid":false,"given":"Alexander R.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geisinger Health Clinic Kidney Health Research Institute Danville PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0993-6839","authenticated-orcid":false,"given":"Daniel A.","family":"Duprez","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000677"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32225-6"},{"key":"e_1_3_2_5_2","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2013","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group . 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Am J Kidney Dis. 2002;39:S1\u2013S266.","journal-title":"Am J Kidney Dis"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(88)90080-7"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2021070988"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwg208"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.116.003458"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/18.6.499"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2019.01.005"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/28.6.1379"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-S081"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-9-31"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100552"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f324"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.03.021"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.12.012"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0190852"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13539-012-0079-1"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.2337\/diaspect.28.3.162"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.026685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:37:09Z","timestamp":1715603829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.026685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":31,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1161\/JAHA.122.026685"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.026685","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]},"assertion":[{"value":"2022-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e026685"}}