Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012

Abstract

Background Prevalence and factors associated with obstructive and restrictive lung function in people with chronic kidney disease (CKD) is unknown. Study Design Cross-sectional and longitudinal analyses Setting & Participants Participants aged 40–79 years from the NHANES (National Health and Nutrition Examination Survey) 2007–2012 who underwent spirometry testing. Predictor CKD (eGFR >15-<60 ml/min/1.73 m2 or urinary albumin-creatinine ratio ≥30 mg/g) Outcomes Restrictive lung function (defined as FEV1/FVC ≥0.70 and baseline FVC <80% predicted), obstructive lung function (defined as FEV1/FVC <0.70 based on post-bronchodilator spirometric results), and mortality data (available for 2007–2008 and 2009–2010 survey periods). Results 7,610 participants (CKD=1338; Non-CKD=6272) were included. The prevalences of obstructive lung function adjusted to the mean age of 55 years and 50% male in the CKD and non-CKD groups were 15.6% and 13.3%, respectively (p=0.2). Similarly, adjusted prevalences of restrictive lung function in the CKD and non-CKD groups were 9.8% and 6.7%, respectively (p=0.01). Presence of albumin-creatinine ratio > 30 mg/g was associated with obstructive (OR, 1.42; 95% CI, 1.07–1.88) and restrictive lung function (OR, 1.43; 95% CI, 1.01–2.03) in the entire study cohort. eGFR < 60 mL/min/1.73m2 was associated with higher odds of obstructive lung function. In a multivariable Cox model, age (HR, 1.07; 95% CI, 1.04–1.11) and presence of obstructive lung function (HR, 2.68; 95% CI, 1.80–3.97) but not CKD measures were associated with death. Limitations Small proportion of participants with advanced kidney disease Conclusions In a representative sample of US adults, impaired lung function is common in those with and without CKD. Albuminuria was independently associated with both obstructive and restrictive lung function, and eGFR < 60 mL/min/1.73m2 was associated with higher odds of obstructive lung function. Older age and obstructive lung function were associated with higher likelihood of death. Further studies examining the burden of lung disease in advanced CKD are needed.

Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease

“…Two studies reported that the prevalence of chronic obstructive pulmonary disease (COPD) was 20%-30% among CKD patients [ 37 , 38 ]; however, these patients had undergone surgical procedures that may represent a selection bias. However, a recent study reported frequencies of OLD (16%) and RLD (10%) in patients with CKD 1–4 [ 39 ] which were similar to those found in the present study.…”

The systemic nature of CKD

“…In a representative sample of US adults, GFR <60 mm/min/1.73 m 2 was associated with an increased risk of obstructive lung disease, whereas albuminuria was associated with obstructive and restrictive lung diseases; these relationships were independent of other risk factors 204 . The link between albuminuria and pulmonary disease is most likely multifactorial.…”

<p>The Impact of Lung Function on Extra-Pulmonary Diseases and All-Cause Mortality in US Adult Population with and without COPD</p>

“…3 In addition to the impact on respiratory health, there is increasing evidence that COPD is associated with morbidity and mortality of some extrapulmonary diseases. [4][5][6][7] However, limited research has focused on the influence and its extent of lung function on these diseases and morbidity in the population with normal lung function compared with COPD patients.…”