Chronological Age: An Overlooked Independent Predictor of Renal Function in Takayasu Arteritis

Ying Wang^1*, Ya-Hong Wang^1*, Li Zhang¹, Zhi-Tong Ge¹, Jing Li², Sheng Cai³, Hong-Yan Wang¹, Xin-Ping Tian², Xiao Yang^1∗, Jian-Chu Li^1∗

* These authors contributed equally to this work.

∗ Corresponding authors

¹Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

²Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

³Department of Health Management, State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

*these authors contributed equally to this work

Correspondence to: Xiao Yang, Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Email: yang_smile@163.com; Jian-Chu Li, Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Email: Jianchuli_0301@163.com

Abstract

To assess whether age independently predicts renal function in Takayasu arteritis (TA) patients with abdominal aortic involvemen. This retrospective study included 149 TA patients. Renal function was assessed by estimated glomerular filtration rate (eGFR). Vascular features (severe RAS, aortic plaques) were evaluated via integrated ultrasound and CT angiography. Univariate and multivariate regression analyses identified determinants of eGFR and clinical renal impairment (eGFR < 90 mL/min/1.73m²). Mean age was 33.85 years. Age showed the strongest inverse correlation with eGFR (r = -0.538, p < 0.001). In multivariate analysis, age remained the most robust independent predictor of lower eGFR (standardized β = -0.500, p < 0.001), exceeding the effect of severe RAS (β = -0.143, p = 0.043). The association of aortic plaques with eGFR lost significance after age adjustment. Logistic regression confirmed age as an independent risk factor for renal impairment (adjusted OR = 1.078 per year, 95% CI: 1.036–1.122, p < 0.001). In TA, chronological age is the strongest independent predictor of renal function, surpassing severe RAS. These findings highlight the necessity of incorporating an age-aware perspective into the clinical assessment of renal health in TA, particularly given its typical onset in young adulthood.

Keywords:

Takayasu arteritis

Renal function

Age

Glomerular filtration rate (eGFR)

Renal artery stenosis

Risk factors

1. Introduction

Takayasu arteritis (TA) is a chronic vasculitis that predominantly affects young adults[1–3]. Renal artery involvement is common and significantly impacts long-term outcomes, primarily through complications such as renovascular hypertension and chronic kidney disease[4,5]. In clinical practice, determining the cause of renal function decline in TA patients remains challenging. As a result, evaluation and management often focus on identifiable disease-specific mechanisms, most notably hemodynamically significant renal artery stenosis (RAS)[6–9].

However, this emphasis on identifiable vascular complications may lead clinicians to overlook a fundamental determinant of kidney health: the patient’s chronological age. It is well established that age is a strong predictor of declining glomerular filtration rate (eGFR) in the general population[10–14]. We propose that in TA—a disease that predominantly affects young adults—the influence of age on renal function is systematically underestimated. The relatively young age of the patient cohort may reduce clinical suspicion for physiological decline, while structural sequelae such as stenosis naturally draw greater diagnostic attention.

Despite the strong rationale, robust evidence directly comparing the influence of age to that of classic disease factors like RAS in TA is lacking. This gap may sustain a clinical approach that misattributes renal function changes. Therefore, this study was designed to test a central hypothesis: Is chronological age a powerful independent predictor of renal function in patients who have TA with abdominal aortic involvement? By answering this question, we aim to refine the current diagnostic paradigm and advocate for a more integrated risk-assessment model that properly weighs the contribution of physiological aging.

2. Methods

2.1 Study Population

This retrospective cohort study was approved by the Institutional Review Board of Peking Union Medical College Hospital. We initially screened 667 patients diagnosed with TA according to the 1990 American College of Rheumatology (ACR) criteria [8]. The exclusion criteria were applied sequentially: absence of abdominal aorta involvement confirmed by either ultrasonography or computed tomography angiography (CTA) (n = 470), age below 18 years (n = 12), unavailability of the research ultrasound examination or conclusive clinical CTA reports (n = 8), and incomplete laboratory data required for the estimation of eGFR within the specified two-week window (n = 48). Consequently, a final cohort of 149 patients with confirmed abdominal aorta involvement and complete datasets was included in the analysis. Demographic and clinical laboratory data collected within a two-week window of the vascular assessment were retrieved for analysis. Renal function was assessed by the eGFR, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on serum creatinine levels.

2.2 Vascular Assessment

The vascular assessment of the abdominal aorta was based on an integrated approach utilizing both a dedicated research ultrasound protocol and a review of clinical CTA data. Two experienced physicians (YHW and YW) performed a comprehensive ultrasound examination using a Philips iU22 system with C5-2 convex (2–5 MHz) and L9-3 linear array (3–9 MHz) transducers. Systematically conducted longitudinal and transverse scans were used to quantitatively evaluate: ① vessel wall thickness; ② residual lumen diameter at the site of maximal stenosis; ③ the presence of plaque (defined as a focal structure encroaching into the lumen by ≥ 1.5 mm or 50% of the surrounding intima-media thickness); and ④ plaque thickness. All ultrasound measurements were obtained in triplicate, and the average value was used. Concurrently, the presence and severity of arterial stenosis (graded as mild [< 50%], moderate [50–70%], or severe [> 70%] lumen reduction) were definitively characterized through a review of all available clinical CTA reports from the Department of Radiology, PUMCH, supplemented by direct image re-evaluation when necessary. This integrated strategy ensured that the final vascular parameters, particularly the classification of severe stenoses, reflected a comprehensive and clinically corroborated evaluation[2,15].

2.3 Statistical Analysis

Data analysis was performed using SPSS 22.0 software (IBM, Chicago, IL, USA). Continuous variables were first assessed for normality using the Shapiro-Wilk test. Categorical variables were presented as frequency (percentage). Group comparisons were conducted using the non-parametric Mann-Whitney U test (for non-normally distributed or ordinal data). Correlation analysis was performed based on the data distribution: Pearson's correlation coefficient was used for normally distributed variables, and Spearman's correlation coefficient was used for non-normally distributed or ordinal variables. To account for multiple comparisons, a Bonferroni correction was applied where appropriate. All tests were two-tailed, with a significance threshold set at p < 0.05.

Table 1

Baseline characteristics of TA patients with abdominal aorta involvement
Characteristic	Value
Total number of patients	149
Female, n(%)	136 (91.3%)
Male, n(%)	13(8.7% )
Mean Age (years)	33.85 ± 11.69
Laboratory Markers
ESR (mm/h)	16.53 ± 19.99
CRP (mg/L)	10.57 ± 25.56
TNF-α (pg/mL)	14.79 ± 38.03
eGFR(mL/min/1.73m² )	109.69 ± 22.46
Presence of Plaques in Abdominal Aorta, n(%)
No Plaques (%)	69 (46.3%)
Plaques (%)	80 (53.7%)
Severe Stenosis in Abdominal Aorta, n(%)	29(19.5%)
Severe Stenosis in Renal Artery, n(%)	42(28.2%)
ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; TNF-α, tumor necrosis factor-alpha; eGFR, estimated glomerular filtration rate.
3.2 Univariate Analysis of Factors Associated with Renal Function
As summarized in Table 2, univariate analysis revealed that patient age, CRP level, and the presence of abdominal aortic plaques were significantly correlated with eGFR. Age exhibited the strongest inverse correlation with eGFR (r = -0.538, p < 0.001). In contrast, CRP demonstrated a positive correlation with eGFR (r = 0.204, p = 0.007). The underlying reason for this counterintuitive finding warrants further investigation, though it may be influenced by confounding factors or the complex interplay between inflammation and renal hemodynamics in TA. Additionally, patients with aortic plaques had significantly lower eGFR compared to those without (r = -0.305, p < 0.001). No significant linear association was observed between severe RAS and eGFR in this univariate analysis (p = 0.183).

Table 2

Univariate Analysis of Factors Associated with eGFR
Variable	Correlation Coefficient (r)	P-value
Continuous Variables
Age	-0.538	< 0.001
CRP	0.204	0.007
Categorical Variables
Abdominal aortic plaque	-0.305	< 0.001
Severe RAS	-0.075	0.183
Pearson's correlation coefficient was used for continuous variables (Age, CRP). Point-biserial correlation coefficient was used for categorical variables (Plaque, Stenosis).
3.3 Multivariate Linear Regression Identifying Independent Determinants of Renal Function
To ascertain the independent contributions of these factors, we performed a series of multivariate linear regression analyses (Table 3). In Model 1, which included age alone, age was strongly and inversely associated with eGFR (standardized β = -0.538, p < 0.001), explaining 29.0% of the variance in eGFR. After introducing CRP into Model 2, its association with eGFR was attenuated and became non-significant (β = 0.113, p = 0.116). When abdominal aortic plaque was added in Model 3, its association with eGFR also lost statistical significance (β = -0.075, p = 0.338), while the effect of age remained stable and significant. This finding confirms our central hypothesis that the apparent link between plaque and eGFR is primarily driven by patient age. In the final model (Model 4), severe RAS was identified as an independent negative predictor of eGFR (β = -0.143, p = 0.043). Despite this, patient age remained the most robust independent factor influencing renal function (β = -0.500, p < 0.001). All regression models were statistically significant (p < 0.001).

Table 3

Multivariate Linear Regression Analysis of Factors Associated with eGFR
Variable	Model 1	Model 2	Model 3	Model 4 (Final)
	Std. β (p-value)	Std. β (p-value)	Std. β (p-value)	Std. β (p-value)
Age	-0.538 (< 0.001)	-0.518 (< 0.001)	-0.488 (< 0.001)	-0.500 (< 0.001)
CRP	—	0.113 (0.116)	0.102 (0.158)	0.121 (0.094)
Abdominal aortic plaque	—	—	-0.075 (0.338)	-0.072 (0.352)
Severe RAS	—	—	—	-0.143 (0.043)
Model R²	0.29	0.302	0.307	0.327
Model p-value	< 0.001	< 0.001	< 0.001	< 0.001
Std. β, standardized beta coefficient; R², coefficient of determination.
All variance inflation factors (VIF) were substantially below 10, indicating no multicollinearity concerns. The dash (—) indicates that the variable was not included in the respective model.
3.4 Multivariate Logistic Regression Identifies Age as a Risk Factor for Clinical Renal Impairment
To further delineate risk factors for clinically significant renal impairment, we performed a multivariate logistic regression analysis with the outcome defined as eGFR < 90 mL/min/1.73m².
The final parsimonious model, which included age and severe RAS, is presented in Table 4. Consistent with the linear regression findings, increasing age was a strong and independent risk factor for clinical renal impairment (adjusted Odds Ratio [OR] = 1.078 per year, 95% Confidence Interval [CI]: 1.036–1.122, p < 0.001). This indicates that for each additional year of age, the odds of having impaired renal function increased by 7.8%. Severe RAS showed a non-significant trend toward a negative association with renal impairment (adjusted OR = 0.371, 95% CI: 0.126–1.093, p = 0.072). The inclusion of abdominal aortic plaque or CRP in the model did not significantly alter the effects of age or RAS, and neither variable was independently associated with the outcome (both p > 0.1). Consequently, they were excluded from the final model to enhance its robustness and clarity.

Table 4

Multivariate Logistic Regression Analysis of Factors Associated with Renal Impairment (eGFR < 90 mL/min/1.73m²)
Variable	B	S.E.	Wald	p-value	Adjusted OR	95% CI for OR
Age (per 1-year increase)	0.075	0.02	13.527	< 0.001	1.078	1.036–1.122
Severe RAS	-0.992	0.552	3.232	0.072	0.371	0.126–1.093
Constant	-4.087	0.869	22.13	< 0.001	0.017
OR, Odds Ratio; CI, Confidence Interval. The model achieved a non-significant result on the Hosmer-Lemeshow test (p > 0.05), indicating a good fit.
3. Discussion
This study directly answers its central research question by demonstrating that in patients with TA and abdominal aortic involvement, patient age is the strongest independent predictor of renal function, surpassing even RAS. While age-related renal decline is well-recognized in general medicine, its significance in TA has been systematically overlooked. Our results challenge the current "disease-centered" clinical approach, which often attributes changes in kidney function solely to active vasculitis or complications such as RAS, thereby underestimating the fundamental role of physiological aging in this population.
The underappreciation of age in the clinical assessment of TA is understandable. TA typically affects younger adults (mean age ~ 34 years in our cohort), which lowers clinical suspicion for age-related functional decline[16–18]. Moreover, more overt disease features such as RAS naturally draw greater clinical attention[7–9,19]. However, our analysis suggests that persistent inflammation and vascular stress in TA may not only cause specific vascular injury but also accelerate kidney aging, potentially through hastening atherosclerotic processes[20–24]. Practically, this implies that the kidneys of a TA patient may be functionally older than their chronological age. This notion is supported by our regression models, in which chronological age emerged as the dominant predictor of renal function (β = −0.500), surpassing even severe RAS. This strong association likely extends beyond natural aging, pointing to a disease-specific process of “accelerated renal aging.” TA is characterized by persistent, low‑grade inflammation, which may foster a pro‑aging microenvironment conducive to oxidative stress, cellular senescence, and epigenetic alterations[25–28]. These mechanisms could effectively decouple biological renal age from chronological time, providing a plausible explanation for why a simple chronological variable outperforms traditional disease markers: age may encapsulate the cumulative toll of both time and the specific disease burden on renal tissue.
Our findings encourage a reevaluation of how other risk factors are interpreted in TA. Although RAS was confirmed as an independent predictor of worse renal function (β = -0.143), its effect size was notably smaller than that of age. This implies that RAS may act as an acute functional insult superimposed upon a gradual, age-related decline. Therefore, before attributing kidney impairment to RAS, clinicians should first assess whether a patient's eGFR is lower than expected for their age[29]. The analysis of aortic plaque illustrates how age can confound clinical interpretation: the association between plaque and reduced eGFR disappeared after adjusting for age, indicating that some imaging findings may reflect aging rather than active disease. Similarly, the initially observed link between higher CRP and better eGFR weakened after accounting for age, highlighting the complex interplay between inflammation, aging, and renal function in TA[30].
Strengths of this study include a well-defined patient cohort, standardized vascular imaging, and statistical methods that isolated the effect of age from other variables. Important limitations must be considered. The retrospective, cross-sectional design precludes causal conclusions and requires prospective validation. The use of creatinine-based eGFR is also less reliable under inflammatory conditions. Furthermore, not all potential confounders—such as long-term blood pressure control—could be fully adjusted for.
The robust association between age and renal function compels a practical shift in clinical assessment. Our data provide direct evidence for establishing an integrated framework: the strong independent association we observed (standardized β = -0.500) quantitatively supports the need to adjust clinical expectations for eGFR based on patient age. We propose that the evaluation of renal health in TA should therefore adopt a two-step approach: first, interpreting a patient’s eGFR with this age-aware perspective to establish a more rational physiological baseline; second, evaluating the superimposed contribution of disease-specific factors, such as RAS, within this context. This integrated framework mitigates the risk of misattributing physiological or accelerated age-related decline solely to active vasculitis, thereby guiding more accurate risk stratification and personalized management decisions.
4. Conclusions
Our study demonstrates that in patients with Takayasu arteritis and abdominal aortic involvement, chronological age is the strongest independent predictor of renal functions. This finding holds critical, yet easily overlooked, clinical significance because TA predominantly affects young adults, a demographic in which physiological aging is rarely considered a primary contributor to organ function decline. By establishing age as the dominant factor even within this young cohort, our results necessitate a shift in the clinical assessment of renal health in TA: from attributing changes predominantly to measurable vascular complications toward an integrated model that places chronological age at the core of personalized risk stratification and management.

2.4 Ethical approval

Patients were informed of the clinical requirements and potential risks

associated with all operations before this study.

This study was approved by the Ethics Committee of the PUMCH.

Results

3.1 Patient Baseline Characteristics

A total of 149 TA patients with abdominal aorta involvement were included in the final analysis (Table 1). The cohort was predominantly female (91.3%), with a mean age of 33.85 ± 11.69 years. The mean eGFR was 109.69 ± 22.46 mL/min/1.73m². Abdominal aortic plaques were identified in 53.7% of patients. Based on the vascular assessment, severe stenosis was present in 19.5% of abdominal aortas and 28.2% of renal arteries.

Acknowledgements

Not applicable

Disclosure

The authors declare no competing interests.

Ethics approval and consent to participate

All procedures performed in the present study involving our participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Author Contribution

Dr. Ying Wang, Dr. Ya-Hong Wang, Dr. Li Zhangand Dr. Zhi-Tong Ge performed the general ultrasound examination and collected the clinical data, and Dr. Ying Wang wrote the manuscript; Dr. Jing Li and Dr. Xin-Ping Tian evaluate the disease activity; Dr. Xiao Yang and Dr. Jianchu Li designed the whole experiments and supervised the whole project. Dr. Hong-Yan Wang and Dr. Sheng Cai reviewed the manuscript. All authors listed in the manuscript are the guarantors of this work and, as such, had full access to all the data used in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This study is supported by National High Level Hospital Clinical Research Funding (2022-PUMCH-A-089,2022-PUMCH-C-053, 2022-PUMCH-B-064).

Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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