Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study.

BACKGROUND: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD).

STUDY DESIGN: Prospective cohort study.

SETTING & PARTICIPANTS: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012.

PREDICTORS: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV/FVC) at baseline determined with spirometry.

OUTCOMES: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level 

RESULTS: During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC

LIMITATIONS: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline.

CONCLUSIONS: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.