Background Obesity may be associated with worse clinical outcomes, including chronic kidney disease. It is unclear if this association is modified by age. Methods In a national cohort of over 3·3 million (n=3,376,187) US veterans with estimated glomerular filtration rate (eGFR) >60ml/min/1·73m2, we examined the association of body mass index (BMI) in patients of different age (<40, 40–<50, 50–<60, 60–<70, 70–<80, and ≥80 years old) with loss of kidney function and with all-cause mortality in logistic regression models and proportional hazards models adjusted for race, gender, comorbidities, medications, and baseline eGFR. Findings A U-shaped association between BMI and loss of kidney function was somewhat consistent and more prominent with advancing age, except in the patients ≤40 years old, in whom BMI did not appear to predict renal function impairment. The lowest risk for loss of kidney function was observed in patients with BMI 25– <30 kg/m2. BMI also displayed a U-shaped association with mortality, which was similar in all age groups. Interpretation BMI ≥30 kg/m2 is associated with rapid loss of kidney function in patients with eGFR ≥60 ml/min/1·73m2, and BMI ≥35 kg/m2 is also associated with high mortality. The former association is accentuated in older patients. A BMI of 25– <30 kg/m2 is associated with optimal clinical outcomes.

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Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m², we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1–1.2), 1.2 (1–1.4), and 1.4 (1.1–1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4–1.7), 1.9 (1.5–2.3), and 2.7 (2–3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

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