Table 1.

Risk factors for de novo CKD as well as preexisting CKD progression

Risk factor	Contribution to de novo CKD	Contribution to CKD progression
Nonmodifiable risk factors
Age	Seen with advancing age, especially in the setting of comorbid conditions	Some suggests that older patients with CKD may have slower progression
Race, genetics and other hereditary factors: •APOL1 gene •Hereditary nephritis (Alport’s)	Common among those with African American ancestors
Acute GN •Postinfectious GN •Rapidly progressive GN	<10%	Recurrent GN or exacerbation of proteinuria
Polycystic kidney disorders	<10%, family history of cystic kidney disorders
Autoimmune disorders •Lupus erythematosus •Other connective tissue disorders (Sjogren’s syndrome)
Congenital anomalies of the kidney and urinary tract	Mostly in children and young adults
Malignancy •Myeloma, light chain deposition disease, AL amyloidosis, and other plasma cell dyscrasias •Lymphoma
Modifiable risk factors
Glycemic control in diabetes mellitus	Approximately 50% of all CKD
Blood pressure control	Approximately 25% of all CKD
Obesity	10%–20%
Smoking	Via both nonhemodynamic and hemodynamic pathways
AKI •ATN •Acute interstitial nephritis	Repeated AKI bouts can cause CKD	Repeated AKI bouts can accelerate CKD progression
Pharmacologic •Medications causing interstitial nephritides (NSAIDs, chemotherapy, PPIs, etc.), ATN (aminoglycosides), renal ischemia and fibrosis (calcineurin inhibitors), crystal nephropathy (phosphate-based bowel preparations, trimethoprim-sulfamethoxazole) •Herbs and herbal medications •Contrast media	Variable, e.g., in Taiwan, Chinese herb nephropathy (due to aristolochic acid) may be an important contributor
Environmental •Heavy-metal exposure	Rare
Acquired or congenital solitary kidney •Cancer, donor or traumatic nephrectomy •Congenital solitary kidney, unilateral atrophic kidney
Acquired urinary tract disorders and obstructive nephropathy	Benign prostatic hypertrophy and prostate cancer in men Gynecologic cancers in women Nephrolithiasis
Inadequate fluid intake •Mesoamerican nephropathy •Others	Unknown risk, but high prevalence is suspected in Central America	Whereas in earlier CKD stages adequate hydration is important to avoid prerenal AKI bouts, higher fluid intake in more advanced CKD may increase the risk of hyponatremia
High protein intake	Unknown risk, recent data suggest higher CKD risk or faster CKD progression with high-protein diet, in particular, from animal sources	Higher protein intake can accelerate the rate of CKD progression
Cardiovascular risk factors and diseases (cardiorenal) •Heart failure •Atherosclerosis	Ischemic nephropathy
Liver disease (hepatorenal)	NASH cirrhosis, viral hepatitis
Endocrine derangements •Testosterone and other androgen supplements •Hypothyroidism

AKI, acute kidney injury; AL, amyloid light-chain; ATN, acute tubular necrosis; CKD, chronic kidney disease; GN, glomerulonephritis; NASH, nonalcoholic steatohepatitis; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.

Many of these risk factors contribute to both de novo CKD and its faster progression and hence are relevant to both primary and secondary prevention.