Association of Obesity and Kidney Function Decline among Non-Diabetic Adults with eGFR &amp;gt; 60 ml/min/1.73m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Malkina, Anna; Katz, Ronit; Shlipak, Michael G.; Ix, Joachim H.; Sarnak, Mark J.; Allison, Matthew; Kramer, Holly; Lin, Julie; Siscovick, David S.; Peralta, Carmen A.

doi:10.4236/ojemd.2013.32016

Cited by 14 publications

(23 citation statements)

References 33 publications

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“…We were unable to fully adjust for risk factors such as glycated haemoglobin, diabetes duration, or drug treatments, which could contribute to the association between obesity and GFR decline. Other filtration markers such as cystatin C were not available to estimate GFR 25 ; however, our results were consistent in analyses using ESKD alone as the outcome. We lacked uniform data on trends in blood pressure control, and thus could not examine whether heterogeneity was explained by differences in treatment intensity.…”

Section: Discussionsupporting

confidence: 78%

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

Chang

Grams

Ballew

et al. 2019

BMJ

169

113

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ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

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Section: Discussionsupporting

confidence: 78%

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

Chang

Grams

Ballew

et al. 2019

BMJ

169

113

View full text Add to dashboard Cite

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“…Race and ethnicity were adjusted for, but not reported separately in this analysis. 29 Conversely, in the CARDIA STudy Grubbs et al reported obesity is associated with incident CKD. 30 Waist circumference and BMI were not associated with rapid decline in this evaluation of the JHS population; however, most subjects had an elevated BMI at baseline.…”

Section: Discussionmentioning

confidence: 97%

Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS)

Young

Katz

Boulware

et al. 2016

American Journal of Kidney Diseases

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Background Racial differences in rapid kidney function decline exist, but less is known regarding factors associated with rapid decline among African Americans. A greater understanding of potentially modifiable risk factors for early kidney function loss may help reduce the burden of kidney failure in this high-risk population. Study Design Prospective cohort study. Setting & Participants 3653 African-American participants enrolled in the Jackson Heart Study (JHS) with kidney function data from two of three examinations (2000-2004 and 2009-2013). Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI creatinine equation. Predictors Demographics, socioeconomic status, lifestyle, clinical risk factors for kidney failure. Outcomes Rapid decline was defined as a ≥ 30% decline in eGFR during follow-up. We quantified the association of risk factors with rapid decline in multivariable models. Measurements Clinical (systolic blood pressure, albuminuria [albumin-creatinine ratio]) and modifiable risk factors. Results Mean age was 54 ± 12 (SD) years, 37% were male, average body mass index was 31.8 ± 7.1 kg/m2, 19% had diabetes mellitus (DM) and mean eGFR was 96.0 ±20 ml/min/1.73m2 with an annual rate of decline of 1.27 ml/min/1.73m2. Those with rapid decline (11.5%) were older, more likely to be of low/middle income, had higher systolic blood pressure, and greater DM than those with non-rapid decline. Factors associated with ≥30% decline were older age (adjusted OR per 10 years older, 1.51; 95% CI, 1.34-1.71); cardiovascular disease (adjusted OR, 1.53; 95% CI, 1.12-2.10), higher systolic blood pressure (adjusted OR per 17 mm Hg greater, 1.22; 95% CI, 1.06-1.41); DM (adjusted OR, 2.63; 95% CI, 2.02-3.41), smoking (adjusted OR, 1.60; 95% CI, 1.10-2.31), and albumin-creatinine ratio > 30 mg/g (adjusted OR, 1.55; 95% CI, 1.08-1.21). Conversely, results did not support associations of waist circumference, C-reactive protein, and physical activity with rapid decline. Limitations No mid study creatinine measurement at examination 2 (2005-2008). Conclusions Rapid decline heterogeneity existed among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.

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“…Obesity has been shown to be a risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). [1][2][3] The prevalence of CKD is increasing worldwide, and the economic burden of its treatment is increasing. Therefore, it is essential to prevent the progression of CKD by detecting renal dysfunction early.…”

Section: Introductionmentioning

confidence: 99%

“…This classification reflects body fat distribution more accurately than describing obesity based only on BMI or the presence of metabolic syndrome. [14][15][16][17] Although several studies have suggested that obesity is associated with early renal dysfunction, 3,6) very few studies have focused on the association between early renal dysfunction and obesity phenotypes in adults without HTN, dyslipidemia, and diabetes.…”

Section: Introductionmentioning

confidence: 99%

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes

et al. 2019

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Background: The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes. Methods: We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m 2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation. Results: Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009-3.236) and 1.834 (95% confidence interval, 1.162-2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline. Conclusion: In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.

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Association of Obesity and Kidney Function Decline among Non-Diabetic Adults with eGFR > 60 ml/min/1.73m<sup>2</sup>: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Cited by 14 publications

References 33 publications

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS)

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes

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