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 Publication2021
AuthorsYu, Z, Grams, ME, Ndumele, CE, Wagenknecht, L, Boerwinkle, E, North, KE, Rebholz, CM, Giovannucci, EL, Coresh, J
JournalAm J Kidney Dis
Volume77
Issue3
Pagination376-385
Date Published2021 03
ISSN1523-6838
KeywordsAfrican Americans, Body Mass Index, Creatinine, European Continental Ancestry Group, Female, Glomerular Filtration Rate, Humans, Kidney Failure, Chronic, Longitudinal Studies, Male, Middle Aged, Obesity, Proportional Hazards Models, Renal Replacement Therapy, Sex Factors, Waist-Hip Ratio
Abstract

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

STUDY DESIGN: Observational study.

SETTING & PARTICIPANTS: 13,496 participants from the Atherosclerosis Risk in Communities (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 level measured at 5 study visits, and incident kidney failure with replacement therapy (KFRT).

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

RESULTS: Baseline mean age was 54 years, median eGFR was 103mL/min/1.73m, and median BMI was 27kg/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, the differences in eGFR slope per 1-SD higher BMI, waist-to-hip ratio, and predicted percent fat were 0.09 (95% CI, -0.18 to 0.36), -0.25 (95% CI, -0.50 to 0.01), and-0.14 (95% CI, -0.41 to 0.13) mL/min/1.73m per decade for White men; -0.91 (95% CI, -1.15 to-0.67), -0.82 (95% CI, -1.06 to-0.58), and-1.02 (95% CI, -1.26 to-0.78) mL/min/1.73m per decade for White women; -0.70 (95% CI, -1.54 to 0.14), -1.60 (95% CI, -2.42 to-0.78), and-1.24 (95% CI, -2.08 to-0.40) mL/min/1.73m per decade for Black men; and-1.24 (95% CI, -2.08 to-0.40), -1.50 (95% CI, -2.05 to-0.95), and-1.43 (95% CI, -2.00 to-0.86) mL/min/1.73m per decade for Black women. Obesity indicators were independently associated with risk for KFRT for all sex-race groups except White men.

LIMITATIONS: Loss to follow-up during 3 decades of follow-up with 5 eGFR assessments.

CONCLUSIONS: Obesity status is a risk factor for future decline in kidney function and development of KFRT 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
PubMed Central IDPMC7904650
Grant ListR01 DK089174 / DK / NIDDK NIH HHS / United States
HHSN268201700002C / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700004C / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700005C / HL / NHLBI NIH HHS / United States
HHSN268201700001C / HL / NHLBI NIH HHS / United States
HHSN268201700003C / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States