Association Between Midlife Obesity and Kidney Function Trajectories: The Atherosclerosis Risk in Communities (ARIC) Study.

TitleAssociation Between Midlife Obesity and Kidney Function Trajectories: The Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2020
AuthorsYu Z, Grams ME, Ndumele CE, Wagenknecht L, Boerwinkle E, North K, Rebholz CM, Giovannucci EL
Secondary AuthorsCoresh JJ
JournalAm J Kidney Dis
Date Published2020 Sep 23
ISSN1523-6838
Abstract

RATIONALE & OBJECTIVE: Obesity has been related to risk of chronic kidney disease (CKD). However, the associations of different measures of midlife obesity with long-term kidney function trajectories and whether they differ by sex and race is unknown.

STUDY DESIGN: Observational study.

SETTING & PARTICIPANTS: 13,496 participants from the ARIC study.

PREDICTORS: Midlife obesity status as measured by body mass index (BMI), waist to hip ratio, and predicted percent fat at baseline.

OUTCOMES: Estimated glomerular filtration rate (eGFR) calculated using serum creatinine measured at 5 study visits and end-stage kidney disease (ESKD).

ANALYTICAL APPROACH: Mixed models with random intercepts and random slopes for eGFR. Cox proportional hazards models for ESKD.

RESULTS: Baseline mean age was 54 years, median eGFR was 103 ml/min/1.73 m, and median BMI was 27 kg/m. Over 30 years of follow-up, midlife obesity measures were associated with eGFR decline in white and black women but not consistently in men. Adjusted for age, center, smoking and coronary heart disease (CHD), the differences (95% CI) in eGFR decline slope (unit: ml/min per 1.73 m per decade) per standard deviation higher BMI, waist to hip ratio, and predicted percent fat were 0.09 (-0.18, 0.36), -0.25 (-0.50, 0.01) and -0.14 (-0.41, 0.13) for white men, -0.91 (-1.15, -0.67), -0.82 (-1.06, -0.58) and -1.02 (-1.26, -0.78) for white women, -0.70 (-1.54, 0.14), -1.60 (-2.42, -0.78) and -1.24 (-2.08, -0.40) for black men, and -1.24 (-2.08, -0.40), -1.50 (-2.05, -0.95) and -1.43 (-2.00, -0.86) for black women. Obesity indicators were independently associated with risk of ESKD for all sex-race groups except white men.

LIMITATIONS: Loss to follow-up during three decades of follow-up with five eGFR measurements.

CONCLUSIONS: Obesity status is a risk factor for future decline in kidney function and development of ESKD in black and white women with less consistent associations among men.

DOI10.1053/j.ajkd.2020.07.025
Alternate JournalAm J Kidney Dis
PubMed ID32979415