Changes in Kidney Function Among Malaysian Adolescents and Its Determinants

Fathhullah Azmie Nawawi; Wan Ahmad Hafiz Wan Md Adnan; Maslinor Ismail; Muhammad Yazid Jalaludin; Hazreen Abdul Majid

doi:10.1016/j.ekir.2023.07.028

Changes in Kidney Function Among Malaysian Adolescents and Its Determinants

Kidney Int Rep. 2023 Aug 5;8(10):1965-1977. doi: 10.1016/j.ekir.2023.07.028. eCollection 2023 Oct.

Authors

Fathhullah Azmie Nawawi^{1

2}, Wan Ahmad Hafiz Wan Md Adnan³, Maslinor Ismail¹, Muhammad Yazid Jalaludin⁴, Hazreen Abdul Majid^{2

5

6}

Affiliations

¹ Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
² Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
³ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁴ Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁵ School of Health and Rehabilitation Sciences, AECC University College, Parkwood Campus, Bournemouth, UK.
⁶ Department of Nutrition, Faculty of Public Health, Universitas of Airlangga, Surabaya, Indonesia.

Abstract

Introduction: The health and wellbeing of adolescents are often neglected, including the knowledge of chronic kidney disease (CKD), especially in its early stages.

Methods: A total of 607 adolescents were recruited from the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study, a prospective cohort study conducted from March 2012 to May 2016 that explored the noncommunicable diseases (NCDs) risk factors among 13 to 17 years old students in 3 states of Peninsular Malaysia. Students who participated in all 3 data collection periods in 2012, 2014, and 2016 with kidney function assessment across all 3-time points were included in the current study. The students' estimated glomerular filtration rate (eGFR) was calculated from isotope-dilution mass spectrometry-traceable Schwartz's equation and categorized based on Kidney Disease: Improving Global Outcomes (KDIGO) classification. Changes in kidney function were examined, and the longitudinal relationship between eGFR and multiple NCD risk factors was analyzed using the generalized estimating equation (GEE).

Results: The prevalence of decreased eGFR (60-89 ml/min per 1.73 m²) among the students increased from 6.1% (2012) to 30.0% (2014) and 40.2% (2016). Based on the GEE, the student's eGFR decreased over time, with a steeper decline during early to midadolescence. Males and rural students had lower eGFR compared to their counterparts. Students who are morbidly obese had lower eGFR than those with normal body mass index (BMI). Protein consumption also has a potential moderating effect on eGFR in adolescents.

Conclusion: Kidney function changes can be detected as early as adolescence and are likely attributable to multiple NCD risk factors. Therefore, more comprehensive prevention efforts from various stakeholders are needed to identify health issues like CKD.

Keywords: adolescent health; chronic kidney disease; glomerular filtration rate; obesity; public health.