Approved Research

LEAP-CKD: Lifestyle, Environment And Physiology: an exploration of the association with future chronic kidney disease

Lay summary

Chronic kidney disease (CKD) is an important public health problem associated with around 20-30,000 excess deaths each year within England. 15% of women over the age of 65 have CKD. Women are more likely to develop CKD in later life than men. This research aims to explore reasons for this difference including lifestyle factors and whether or not having children impacts upon future risk of developing CKD.

Factors such as physical activity, diet and socio-economic background are likely to influence a person's risk of developing CKD. We know that certain 'healthy' choices are associated with reduced risk of developing CKD; we do not know if these factors also affect progression of CKD. In CKD 'healthy' diets are often difficult to achieve and advice may be given to restrict healthy foods like fruit and vegetables. Additionally lifestyle factors associated with being a parent (or not) may also impact on a person's risk of CKD. We will explore the role of lifestyle factors, which are important to both men and women, in the development and progression of CKD. This is an important public health issue as CKD is both a common and a serious illness, modification of lifestyle factors could be a simple way to reduce its impact.

In women specifically, we do not know whether or not the changes a woman's body goes through as a result of becoming pregnant and delivering a child impact her future risk of CKD. During pregnancy blood flow to the kidneys increases by more than 50% and the filtering units of the kidney (glomeruli) filter 50% more blood and waste products. The kidneys change structure during pregnancy and become more swollen with water (hydronephrosis). Hormonal changes occur, including increased activity of the renin-angiotensin-aldosterone system which affects blood pressure and salt and water retention. Some pregnancy complications (eg high blood pressure) are associated with increased risk of future CKD but we don't know what effect the changes which occur during healthy pregnancy might have on a women's future health.  It might be that the total number of pregnancies that a woman has, the age she is when she has children, the gap between pregnancies or whether she has multiple pregnancies influences her future CKD risk.  Answering these questions should help to direct future research and enable women and men to make informed choices in the future. This project will take around 36 months to complete.

Scope extension:

This study aims to explore risk factors for kidney disease amongst women and men and to explore any potential associations with socio-economic status, general lifestyle, dietary intake, physical activity levels, environment and maternal and child raising (being a parent) history. In particular it aims to address the questions: Is there an association between deprivation and risk of chronic kidney diseases? How do physical activity and dietary intake influence progression of kidney disease? Do plant based diets or diets rich in green vegetables offer any protection against chronic kidney disease (CKD) progression? Furthermore, we will address whether life events such as normal pregnancy impact on the future risk of kidney disease. What effect does the number of children you had have on future kidney disease? Does the interval between pregnancies influence future risk of kidney disease? Does maternal or paternal age at delivery influence future risk of kidney disease? How do lifestyle factors which are influenced by being a parent impact upon future risk of kidney disease?

We also wish to consider any potential associations of early CKD with LV systolic function, geometry, and vascular health within the BIOBANK population. We hypothesise that changes in LV function and structure occur during the early stages of CKD and that these changes may be influenced by the lifestyle, environmental and reproductive factors outlined above. Further more we wish to investigate whether any detectable myocardial changes correlate with long-term clinical outcomes including heart failure, coronary artery disease and cardiac death.