TY - JOUR
T1 - Association Between Midlife Obesity and Kidney Function Trajectories
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Yu, Zhi
AU - Grams, Morgan E.
AU - Ndumele, Chiadi E.
AU - Wagenknecht, Lynne
AU - Boerwinkle, Eric
AU - North, Kari E.
AU - Rebholz, Casey M.
AU - Giovannucci, Edward L.
AU - Coresh, Josef
N1 - Funding Information:
Zhi Yu, BM, PhD, Morgan E. Grams, MD, PhD, Chiadi E. Ndumele, MD, PhD, Lynne Wagenknecht, PhD, Eric Boerwinkle, PhD, Kari North, PhD, Casey M. Rebholz, PhD, Edward L. Giovannucci, MD, ScD, and Josef Coresh, MD, PhD. Research idea and study design: ZY, MEG, JC; data acquisition: JC; data analysis/interpretation: ZY, MEG, CEN, LW, EB, KN, CMR, ELG, JC; statistical analysis: ZY, MEG, JC; supervision or mentorship: MEG, JC. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. The ARIC Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. Funding for laboratory testing and biospecimen collection at ARIC visit 6 was supported by grant R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH. None of the funders had any role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit this report for publication. The authors declare that they have no other relevant financial interests. The authors thank the staff and participants of the ARIC Study for important contributions. Some of the data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government. Received November 19, 2019. Evaluated by 2 external peer reviewers and a statistician, with direct editorial input from an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form July 21, 2020. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2021/3
Y1 - 2021/3
N2 - 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 103 mL/min/1.73 m2, and median BMI was 27 kg/m2. 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/1.73 m2 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/1.73 m2 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/1.73 m2 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/1.73 m2 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.
AB - 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 103 mL/min/1.73 m2, and median BMI was 27 kg/m2. 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/1.73 m2 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/1.73 m2 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/1.73 m2 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/1.73 m2 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.
KW - Obesity
KW - bioelectrical impedance analysis (BIA)
KW - body fat
KW - body mass index (BMI)
KW - chronic kidney disease (CKD)
KW - end-stage renal disease (ESRD)
KW - estimated glomerular filtration rate (eGFR)
KW - kidney disease progression
KW - kidney failure
KW - kidney function
KW - midlife
KW - modifiable risk factor
KW - racial/ethnic differences
KW - sex differences
KW - trajectory
KW - waist-to-hip ratio
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U2 - 10.1053/j.ajkd.2020.07.025
DO - 10.1053/j.ajkd.2020.07.025
M3 - Article
C2 - 32979415
AN - SCOPUS:85097456139
SN - 0272-6386
VL - 77
SP - 376
EP - 385
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -