Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

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Abstract

Objective

To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.

Design

Individual participant data meta-analysis.

Setting

Cohorts from 40 countries with data collected between 1970 and 2017.

Participants

Adults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).

Main outcome measures

GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m ²) and all cause mortality.

Results

Over a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.

Conclusions

Elevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

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Most cited references 20

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Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Marie Ng, Tom Fleming, Margaret W. Robinson … (2015)

In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Body mass index and the risk of development of end-stage renal disease in a screened cohort.

Kunitoshi Iseki, K. Kinjo, Shuichi Takishita … (2004)

Obesity is associated with proteinuria and could be a risk factor for end-stage renal disease (ESRD). However, few studies have examined the significance of body mass index (BMI) as a risk factor for the development of ESRD in the general population. We examined the relationship between BMI and the development of ESRD using data from a 1983 community-based screening in Okinawa, Japan. Screenees who developed ESRD by the end of 2000 were identified through the Okinawa Dialysis Study registry. BMI data were available for 100,753 screenees (47,504 men and 53,249 women) aged >/=20 years. The cumulative incidence of ESRD was analyzed according to the quartile of BMI: /=25.5 kg/m(2). The mean (SD) BMI of the screenees was 23.4 (3.3) kg/m(2) (range 7.9 to 59.1 kg/m(2)); the mean was 23.4 kg/m(2) for both men and women. During the follow-up period, 404 screenees (232 men and 172 women) developed ESRD. The cumulative incidences of ESRD per 1000 screenees were, from the lowest to highest BMI quartile, 2.48, 3.79, 3.86, and 5.81. The odds ratio (95% CI) of BMI for developing ESRD, after adjustment for age, sex, systolic blood pressure, and proteinuria, was 1.273 (1.121-1.446, P= 0.0002) for men and 0.950 (0.825-1.094, not significant) for women. We found that BMI was associated with an increased risk of the development of ESRD in men in the general population in Okinawa. The maintenance of optimal body weight may reduce the risk of ESRD.

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A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population.

Carlo Garofalo, Silvio Borrelli, Roberto Minutolo … (2017)

Obesity and chronic kidney disease (CKD) are public health priorities that share core pathophysiological mechanisms. However, whether high body mass index (BMI) increases risk of CKD de novo remains ill-defined. To evaluate the role of BMI in predicting CKD onset in the general adult population, we performed a systematic review and meta-analysis of PubMed and ISI Web of Science databases articles published between January 2000 and August 2016 without language restriction. We selected studies in adult individuals from a general population with normal renal function at baseline that reported the risk of low estimated glomerular filtration (eGFR) (under 60 mL/min/1.73m(2)) and/or albuminuria (1+ at dipstick or an albumin creatinine ratio of 3.4 mg/mmol or more) as hazard ratio, odds ratio or relative risk related to obesity, overweight, or BMI as continuous value. A total of 39 cohorts covering 630, 677 participants with a mean follow-up of 6.8 years were selected. Obesity increased the relative risk, 95% confidence interval and heterogeneity (I(2)) of developing low eGFR (1.28, 1.07-1.54, [I(2): 95.0%]) and albuminuria (1.51, 1.36-1.67, [I(2): 62.7%]). Increase of BMI unit was also associated with higher risk of low eGFR (1.02, 1.01-1.03, [I(2): 24.3%]) and albuminuria (1.02, 1.00-1.04, [I(2): 0%]). Conversely, overweight did not predict onset of either low eGFR (1.06, 0.94-1.21, [I(2): 50.0%]) or albuminuria (1.24, 0.98-1.58, [I(2): 49.4%]). Thus, a high BMI predicts onset of albuminuria without kidney failure (CKD stages 1-2) as well as CKD stages 3 and higher, the effect being significant only in obese individuals. Hence, our findings may have implications to improve risk stratification and recommendations on body weight control in the general population.

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Author and article information

Contributors

Alex R Chang: Role: assistant professor

Morgan E Grams:

ORCID: http://orcid.org/0000-0002-4430-6023

Role: associate professor

Shoshana H Ballew: Role: assistant scientist

Henk Bilo: Role: professor

Adolfo Correa: Role: professor

Marie Evans: Role: nephrologist

Orlando M Gutierrez: Role: professor

Farhad Hosseinpanah: Role: associate professor

Kunitoshi Iseki: Role: director

Timothy Kenealy: Role: associate professor

Barbara Klein: Role: professor

Florian Kronenberg: Role: professor

Brian J Lee: Role: nephrologist

Yuanying Li: Role: researcher

Katsuyuki Miura: Role: professor

Sankar D Navaneethan: Role: associate professor

Paul J Roderick: Role: professor

Jose M Valdivielso: Role: principal investigator

Frank L J Visseren: Role: professor

Luxia Zhang: Role: professor

Ron T Gansevoort: Role: professor

Stein I Hallan: Role: professor

Andrew S Levey: Role: professor

Kunihiro Matsushita: Role: associate professor

Varda Shalev: Role: director

Mark Woodward: Role: professor

Journal

Journal ID (nlm-ta): BMJ

Journal ID (iso-abbrev): BMJ

Journal ID (publisher-id): BMJ-UK

Journal ID (hwp): bmj

Title: The BMJ

Publisher: BMJ Publishing Group Ltd.

ISSN (Print): 0959-8138

ISSN (Electronic): 1756-1833

Publication date Collection: 2019

Publication date (Electronic): 10 January 2019

Volume: 364

Electronic Location Identifier: k5301

Affiliations

[1 ]Kidney Health Research Institute, and Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA, USA

[2 ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

[3 ]Diabetes Centre, Isala, and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

[4 ]Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

[5 ]Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden and Swedish Renal Registry, Jönköping, Sweden

[6 ]Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

[7 ]Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

[8 ]Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[9 ]Dialysis Unit, University of the Ryukyus Hospital, Nishihara, Japan

[10 ]Yuuaikai Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan

[11 ]Departments of Medicine and General Practice & Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand

[12 ]Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

[13 ]Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria

[14 ]Kaiser Permanente, Hawaii Region, Moanalua Medical Center, Honolulu, HI, USA

[15 ]Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan

[16 ]Department of Public Health, Shiga University of Medical Science, Otsu, Japan

[17 ]Section of Nephrology, Baylor College of Medicine, Houston, TX, USA

[18 ]Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK

[19 ]Vascular and Renal Translational Research Group, REDinREN del ISCIII, IRBLleida, Lleida, Spain

[20 ]Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands

[21 ]Peking University Institute of Nephrology, Division of Nephrology, Peking University First Hospital, Beijing, China

[22 ]Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

[23 ]Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim, Norway

[24 ]Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway

[25 ]Division of Nephrology at Tufts Medical Center, Boston, MA, USA

[26 ]Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

[27 ]George Institute for Global Health, University of Oxford, Oxford, UK

[28 ]George Institute for Global Health, University of New South Wales, Sydney, Australia

Author notes

Correspondence to: M E Grams, Chronic Kidney Disease Prognosis Consortium Data Coordinating Center, 2024 E Monument Street, Baltimore, MD 21205, USA ckdpc@ 123456jhmi.edu

Author information

Morgan E Grams http://orcid.org/0000-0002-4430-6023

Article

Publisher ID: chaa045978

DOI: 10.1136/bmj.k5301

PMC ID: 6481269

PubMed ID: 30630856

SO-VID: d28b70c6-5357-4eb6-bec4-212498f63c8a

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

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Abstract

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

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Most cited references 20

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Body mass index and the risk of development of end-stage renal disease in a screened cohort.

A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population.

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