"What we found was that the risk of death and cardiovascular disease increased as kidney function declined," says lead author Dr. Alan S. Go. "Even at relatively modest levels of kidney disease ”so low that a person may not know they have it ”the risk increased significantly."

The retrospective cohort study evaluated the histories of more than 1.1 million adults who were patients of Kaiser Permanente between 1996 and 2000. The average age of the group studied was 52 years; 55% of the group was female.

As the ability of the kidneys to filter out the body's toxins decreased, also known as the glomerular filtration rate or GFR, the risk of death increased proportionally. At a modest level of dysfunction, the risk of death was increased by 17%, while at the lowest levels, the risk increased nearly sixfold.

"The most important message to take away from this study is that patients who are at any risk of kidney disease ”because of family history, high blood pressure, or diabetes ”should be screened by their doctors to measure their kidney function. Caught early, kidney disease can be managed through diet and medication and these risks can hopefully be lowered."

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Employment grade was divided into three categories: administrative (the seven highest paying grades), executive (including senior executive officers, higher executive officers, executive officers and other professional and technical staff receiving similar salaries), and clerical (including clerical and office support grades). Participants also answered questions regarding family history of diabetes, coronary risk factors (including smoking, alcohol consumption, exercise habits and diet), and psychosocial questions regarding work, social support, depression, and relationships.

The researchers found that over an average follow-up time of 10.5 years, 4 percent of the participants (242 men and 119 women) developed diabetes. Men working in lower employment grades had almost three times the risk of developing diabetes, and women had a 70 percent higher risk of developing diabetes than participants in higher employment grades. Participants whose body mass index (BMI) indicated overweight (BMI, 25.0-29.9) or obesity (BMI, 30 or greater) were at increased risk of diabetes. Among the psychosocial risk factors examined, only effort-reward imbalance was associated with diabetes, and only in men, who had a 70 percent greater chance of developing diabetes if they reported experiencing effort-reward imbalance.

"We have demonstrated that there is a social gradient in incidence of type 2 diabetes in middle-aged men and women in white-collar occupations," write the researchers. "In addition, we show that effort-reward imbalance is associated with incidence of type 2 diabetes in men only."

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