Mendelian randomization analysis revealed that albuminuria is the key factor affecting socioeconomic status in CKD patients

Abstract

Previous studies indicate a strong correlation between the incidence of chronic kidney disease (CKD) and lower economic status. However, these studies often struggle to delineate a clear cause-effect relationship, leaving healthcare providers uncertain about how to manage kidney disease in a way that improves patients' financial outcomes. Our study aimed to explore and establish a causal relationship between CKD and socioeconomic status, identifying critical influencing factors. We utilized summary meta-analysis data from the CKDGen Consortium and UK Biobank. Genetic variants identified from these sources served as instrumental variables (IVs) to estimate the association between CKD and socioeconomic status. The presence or absence of CKD, estimated glomerular filtration rate (eGFR), and albuminuria were used as exposures, while income and regional deprivation were analyzed as outcomes. We employed the R packages 'TwoSampleMR' and 'Mendelianrandomization' to conduct both univariable and multivariable Mendelian randomization (MR) analyses, assessing for potential pleiotropy and heterogeneity. Our univariable MR analysis revealed a significant causal relationship between high levels of albuminuria and lower income (OR = 0.84, 95% CI: 0.73-0.96, p = 0.013), with no significant pleiotropy detected. In the multivariable MR analysis, both CKD (OR = 0.867, 95% CI: 0.786-0.957, p = 0.0045) and eGFR (OR = 0.065, 95% CI: 0.010-0.437, p = 0.0049) exhibited significant effects on income. This study underscores that higher albuminuria levels in CKD patients are associated with decreased income and emphasizes the importance of effective management and treatment of albuminuria in CKD patients to mitigate both social and personal economic burdens.

Keywords: Chronic kidney disease; Mendelian randomization; albuminuria; renal injury; socioeconomic status.

Figure 1.

An overview of this study. Utilizes univariable and multivariable Mendelian randomization to assess the impact of CKD, eGFR, and albuminuria on socioeconomic status, with key genetic instruments indicated as SNPs.

Figure 2.

The Forest plot of Mendelian randomization analysis between CKD, eGFR, albuminuria and socioeconomic status.

Figure 3.

Funnel plots of causal effects assessed by IVW and MR egger methods. This figure illustrates the distribution of causal effects of CKD renal injury on socioeconomic status through funnel plots. (A) Causal effects of CKD on income, (B) on total deprivation index (TDI), (C) causal effects of eGFR on income, (D) on TDI, (E) causal effects of albuminuria on income, and (F) on TDI.