IntroductionThe increasing prevalence of chronic kidney disease (CKD), with its associated high annual rates of mortality and cardiovascular complications ( 1 -3 ), is a major public health problem. In Japan, clinical practice guidelines established by the Japanese Society of Nephrology estimate that 18.7% of adults have CKD, which is defined as kidney damage or glomerular filtration rate (GFR) < 60 mL/min/1.73 m 2 for 3 months or more regardless of cause ( 4 ), and 4.1% have moderate or severe CKD ( 5 ). Identifying risk factors for CKD is critical in order to devise effective, population-based preventive strategies. Obesity is also a major worldwide public health problem. Obesity increases the risk of cardiovascular disease, diabetes, hypertension, and dyslipidemia (6, 7). However, few studies have examined the relationship between excess weight and CKD risk. Obese patients are at a higher risk for focal segmental glomerulosclerosis and glomerulomegaly (8) Vol. 31, No. 8 (2008) (9). In Western countries, many patients have an estimated GFR (eGFR) of less than 60 mL/min/1.73 m 2 or a body mass index (BMI) of 30 kg/m 2 or more. However, the risk of slightly elevated weight (BMI, 22.0 to 24.9 kg/m 2 ) in a Japanese population for mildly reduced renal function (eGFR, 60 to 90 mL/min/1.73 m 2 ) is not clear. We evaluated the relationship of BMI to potential risk factors such as hypertension, hyperglycemia, and lipids, as well as to renal function, using cross-sectional data from community-dwelling participants.
Methods
SubjectsParticipants were recruited at the time of their annual health examination in a rural town that has a total population of 11,136 (as of April 2002) and located in Ehime Prefecture, Japan, in 2002. Among the 9,133 adults aged 19 to 90 years in this population, 3,164 (34.6%) subjects met the eligibility requirements to participate in the study. Information on medical history, present conditions, and drugs was obtained by interview. Subjects with a clinical history of stroke, transient ischemic attack, myocardial infarction, or angina were excluded. Subjects taking medications for hypertension, diabetes, or dyslipidemia were also excluded from the study. However, participants that met the eligibility requirements with BMI> 30 kg/m 2 were included (37 subjects). The final study sample included 1,716 eligible persons. All procedures were approved by the Ethics Committee of Ehime University School of Medicine.
Evaluation of Risk FactorsWe measured blood pressure in the right upper arm of participants in a seated position using an automatic oscillometric blood pressure recorder. Cigarette smoking was quantified based on daily consumption and on duration of smoking. Fasting total cholesterol (T-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), creatinine (enzymatic method), and uric acid were measured during fasting. Low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald formula (10). Participants with TG levels ≥ 4...