Educational Attainment Is Associated With Kidney and Cardiovascular Outcomes in the German CKD (GCKD) Cohort

Winitzki D, Zacharias HU, Nadal J, Baid-Agrawal S, Schaeffner E, Schmid M, Busch M, Bergmann MM, Schultheiss U, Kotsis F, Stockmann H, Meiselbach H, Wolf G, Krane V, Sommerer C, Eckardt KU, Schneider M, Schlieper G, Floege J, Saritas T (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Kidney International Reports Elsevier

DOI: 10.1016/j.ekir.2022.02.001

Abstract

Introduction: Prospective data on impact of educational attainment on prognosis in patients with chronic kidney disease (CKD) are scarce. We investigated the association between educational attainment and all-cause mortality, major adverse cardiovascular (CV) events (MACEs), kidney failure requiring dialysis, and CKD etiology. Methods: Participants (N = 5095, aged 18–74 years) of the ongoing multicenter German Chronic Kidney Disease (GCKD) cohort, enrolled on the basis of an estimated glomerular filtration rate (eGFR) of 30 to 60 ml/min (stages G3, A1–A3) or overt proteinuria (stages G1–G2, A3), were divided into 3 categories according to their educational attainment and were followed for 6.5 years. Results: Participants with low educational attainment (vs. high) had a higher risk for mortality (hazard ratio [HR] 1.48, 95% CI: 1.16–1.90), MACE (HR 1.37, 95% CI: 1.02–1.83), and kidney failure (HR 1.54, 95% CI: 1.15–2.05). Mediators between low educational attainment and mortality were smoking, CV disease (CVD) at baseline, low income, higher body mass index, and higher serum levels of CRP, high-density lipoprotein cholesterol, uric acid, NGAL, BAP, NT-proBNP, OPN, H-FABP, and urea. Low educational attainment was positively associated with diabetic nephropathy (odds ratio [OR] 1.65, 95% CI: 1.36–2.0) and CKD subsequent to acute kidney injury (OR 1.56, 95% CI: 1.03–2.35), but negatively associated with IgA nephropathy (OR 0.68, 95% CI: 0.52–0.90). Conclusion: Low educational attainment is associated with adverse outcomes and CKD etiology. Lifestyle habits and biomarkers mediate associations between low educational attainment and mortality. Recognition of the role of educational attainment and the associated health-relevant risk factors is important to optimize the care of patients with CKD and improve prognosis.

Authors with CRIS profile

Heike Meiselbach Department of Medicine 4 – Nephrology and Hypertension Kai-Uwe Eckardt
Markus Schneider Medizinische Fakultät

Involved external institutions

Universitätsklinikum Aachen (UKA) DE Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Universitätsklinikum Bonn DE Germany (DE) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset SE Sweden (SE) Charité - Universitätsmedizin Berlin DE Germany (DE) Universitätsklinikum Jena DE Germany (DE) Deutsches Institut für Ernährungsforschung (DIfE) DE Germany (DE) Albert-Ludwigs-Universität Freiburg DE Germany (DE) Universitätsklinikum Würzburg DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE)

How to cite

APA:

Winitzki, D., Zacharias, H.U., Nadal, J., Baid-Agrawal, S., Schaeffner, E., Schmid, M.,... Saritas, T. (2022). Educational Attainment Is Associated With Kidney and Cardiovascular Outcomes in the German CKD (GCKD) Cohort. Kidney International Reports. https://doi.org/10.1016/j.ekir.2022.02.001

MLA:

Winitzki, Doris, et al. "Educational Attainment Is Associated With Kidney and Cardiovascular Outcomes in the German CKD (GCKD) Cohort." Kidney International Reports (2022).

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