TY - JOUR
T1 - Adiposity and risk of decline in glomerular filtration rate
T2 - meta-analysis of individual participant data in a global consortium
AU - CKD-PC
AU - Chang, Alex R.
AU - Grams, Morgan
AU - Ballew, Shoshana H.
AU - Bilo, Henk
AU - Correa, Adolfo
AU - Evans, Marie
AU - Gutierrez, Orlando M.
AU - Hosseinpanah, Farhad
AU - Iseki, Kunitoshi
AU - Kenealy, Timothy
AU - Klein, Barbara
AU - Kronenberg, Florian
AU - Lee, Brian J.
AU - Li, Yuanying
AU - Miura, Katsuyuki
AU - Navaneethan, Sankar D.
AU - Roderick, Paul J.
AU - Valdivielso, Jose M.
AU - Visseren, Frank L. J.
AU - Zhang, Luxia
AU - Gansevoort, Ron T.
AU - Hallan, Stein I.
AU - Levey, Andrew S.
AU - Matsushita, Kunihiro
AU - Shalev, Varda
AU - Woodward, Mark
AU - Astor, Brad
AU - Appel, Larry
AU - Greene, Jane H.
AU - Chen, Teresa
AU - Chalmers, John
AU - Arima, Hisatomi
AU - Perkovic, Vlado
AU - Yatsuya, Hiroshi
AU - Tamakoshi, Koji
AU - Hirakawa, Yoshihisa
AU - Coresh, Josef
AU - Zhao, Minghui
AU - Bakker, Stephan J. L.
AU - Heerspink, Hiddo J. L.
AU - de Zeeuw, Dick
AU - Landman, Gijs W. D.
AU - Kleefstra, Nanne
PY - 2019/1/10
Y1 - 2019/1/10
N2 - 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 m(2)) 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.
AB - 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 m(2)) 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.
KW - BODY-MASS INDEX
KW - CHRONIC KIDNEY-DISEASE
KW - ALL-CAUSE MORTALITY
KW - WAIST CIRCUMFERENCE
KW - OBESITY PARADOX
KW - ASSOCIATION
KW - WEIGHT
KW - CKD
U2 - 10.1136/bmj.k5301
DO - 10.1136/bmj.k5301
M3 - Article
SN - 1756-1833
VL - 364
JO - BMJ-British Medical Journal
JF - BMJ-British Medical Journal
M1 - 5301
ER -