TY - JOUR
T1 - Lung Function and Incident Kidney Disease
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Sumida, Keiichi
AU - Kwak, Lucia
AU - Grams, Morgan E.
AU - Yamagata, Kunihiro
AU - Punjabi, Naresh M.
AU - Kovesdy, Csaba P.
AU - Coresh, Josef
AU - Matsushita, Kunihiro
N1 - Funding Information:
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 an official policy or interpretation of the US government. Support: The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts ( HHSN268201100005C , HHSN268201100006C , HHSN268201100007C , HHSN268201100008C , HHSN268201100009C , HHSN268201100010C , HHSN268201100011C , and HHSN268201100012C ). The funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. Financial Disclosure: The authors declare that they have no other relevant financial interests. Contributions: Research idea and study design: KS, KM; data acquisition: KS, KM; data analysis/interpretation: KS, LK, MEG, KY, NP, CPK, JC, KM; statistical analysis: KS, KM; supervision or mentorship: KY, CPK, KM. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Peer Review: Evaluated by 2 external peer reviewers, with editorial input from a Statistics/Methods Editor and an Acting Editor-in-Chief.
Publisher Copyright:
© 2017 National Kidney Foundation, Inc.
PY - 2017/11
Y1 - 2017/11
N2 - 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 (FEV1/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 <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. 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 FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80% and FEV1/FVC < 70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80% and FEV1/FVC ≥ 70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80% and FEV1/FVC < 70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC ≥ 70%, or percent-predicted FVC ≥ 80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. 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.
AB - 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 (FEV1/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 <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. 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 FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80% and FEV1/FVC < 70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80% and FEV1/FVC ≥ 70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80% and FEV1/FVC < 70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC ≥ 70%, or percent-predicted FVC ≥ 80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. 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.
KW - Atherosclerosis Risk in Communities (ARIC) Study
KW - Lung function
KW - chronic kidney disease (CKD)
KW - end-stage renal disease (ESRD)
KW - estimated glomerular filtration rate (eGFR)
KW - obstructive lung function
KW - restrictive lung function
KW - spirometry
UR - http://www.scopus.com/inward/record.url?scp=85025813943&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85025813943&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2017.05.021
DO - 10.1053/j.ajkd.2017.05.021
M3 - Article
C2 - 28754455
AN - SCOPUS:85025813943
SN - 0272-6386
VL - 70
SP - 675
EP - 685
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -