Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease

Abstract

Background:The relationship between adolescent body mass index (BMI) and future risk for end-stage renal disease (ESRD) is not fully understood, nor is it known the extent to which this association is limited to diabetic ESRD. We evaluated the association between BMI in adolescence and the risk for all-cause, diabetic, and nondiabetic ESRD.Methods: Medical data about 1 194 704 adolescents aged 17 years who had been examined for fitness for military service between January 1, 1967, and December 31, 1997, were linked to the Israeli ESRD registry in this nationwide population-based retrospective cohort study. Incident cases of treated ESRD between January 1, 1980, and May 31, 2010, were included. Cox proportional hazards models were used to estimate the hazard ratio (HR) for treated ESRD among study participants for their BMI at age 17 years, defined in accord with the US Centers for Disease Control and Prevention BMI for age and sex classification.Results: During 30 478 675 follow-up person-years (mean [SD], 25.51 [8.77] person-years), 874 participants (713 male and 161 female) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100 000 person-years. Compared with adolescents of normal weight, overweight adolescents (85th to 95th percentiles of BMI) and obese adolescents (Ն95th percentile of BMI) had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100 000 person-years, respectively. In a multivariate model adjusted for sex, country of origin, systolic blood pressure, and period of enrollment in the study, overweight was associated with an HR of 3.00 (95% CI, 2.50-3.60) and obesity with an HR of 6.89 (95% CI, 5.52-8.59) for all-cause treated ESRD. Overweight (HR, 5.96; 95% CI,) and obesity (HR, 19.37; 95% CI,) were strong and independent risk factors for diabetic ESRD. Positive associations of overweight (HR, 2.17; 95% CI, 1.71-2.74) and obesity (HR, 3.41; 95% CI, 2.42-4.79) with nondiabetic ESRD were also documented.Conclusions: Overweight and obesity in adolescents were associated with significantly increased risk for all-cause treated ESRD during a 25-year period. Elevated BMI constitutes a substantial risk factor for diabetic and nondiabetic ESRD.

Health-Risk Factors and 8-Year Incidence of Kidney Disease in Transitional Thailand: Prospective Findings From a Large National Cohort Study

“…Similar results were revealed in previous cross-sectional studies in Korea (Kim et al, 2009;Park et al, 2016), China (Du et al, 2017), Singapore (Ramirez et al, 2002) and Australia (White et al, 2008) and in follow up studies of 10 to 12 years in the US (Grubbs et al, 2014;Stengel, Tarver-Carr, Powe, Eberhardt, & Brancati, 2003) and 25 years in Israeli (Vivante et al, 2012). The US study of Grubbs et al (2014) found that increasing BMI was significantly associated with lower kidney function.…”

“…In Singapore a higher BMI associated with rising proteinuria (Ramirez et al, 2002). In a prospective cohort of Israeli soldiers obesity was significantly associated with an increased risk of incident ESRD (Vivante et al, 2012). A British cohort study revealed that obesity when young (less than 40 years) was significantly associated with a higher risk of KD incidence (Silverwood et al, 2013).…”

Obesity and Kidney Disease: Hidden Consequences of the Epidemic

“…Furthermore, in numerous large population-based studies, higher BMI appears associated with the presence 8,12 and development of low estimated glomerular filtration rate (GFR), 9,10,13 with more rapid loss of estimated GFR over time, 14 and with the incidence of ESRD. [15][16][17][18] Elevated BMI levels, class II obesity and above, have been associated with more rapid progression of CKD in patients with pre-existing CKD. 19 A few studies examining the association of abdominal obesity using WHR or WC with CKD, describe an association between higher girth and albuminuria, 20 Higher visceral adipose tissue measured by computed tomography has been associated with a higher prevalence of albuminuria in men.…”

Obesity and kidney disease: hidden consequences of the epidemic

“…Higher BMI is associated with the presence 8 and development [9][10][11] of proteinuria in individuals without kidney disease. Furthermore, in numerous large population-based studies, higher BMI appears associated with the presence 8,12 and development of low estimated GFR 9,10,13 , with more rapid loss of estimated GFR over time, 14 and with the incidence of ESRD [15][16][17][18] . Elevated BMI levels, class II obesity and above, have been associated with more rapid progression of CKD in patients with pre-existing CKD 19 .…”