BACKGROUND: Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline. STUDY DESIGN: Longitudinal cohort. SETTING & PARTICIPANTS: 2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. PREDICTOR: BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2). OUTCOMES: Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys <60mL/min/1.73m(2) over 10 years of follow-up. MEASUREMENTS: GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20. RESULTS: At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). In unadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant. LIMITATIONS: Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level. CONCLUSIONS: Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.
BACKGROUND: Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline. STUDY DESIGN: Longitudinal cohort. SETTING & PARTICIPANTS: 2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. PREDICTOR: BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2). OUTCOMES: Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys <60mL/min/1.73m(2) over 10 years of follow-up. MEASUREMENTS: GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20. RESULTS: At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). In unadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant. LIMITATIONS: Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level. CONCLUSIONS: Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.
Authors: Rebecca P Gelber; Tobias Kurth; Annamaria T Kausz; Joann E Manson; Julie E Buring; Andrew S Levey; J Michael Gaziano Journal: Am J Kidney Dis Date: 2005-11 Impact factor: 8.860
Authors: Michael G Shlipak; Ronit Katz; Mark J Sarnak; Linda F Fried; Anne B Newman; Catherine Stehman-Breen; Stephen L Seliger; Brian Kestenbaum; Bruce Psaty; Russell P Tracy; David S Siscovick Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Ian H de Boer; Ronit Katz; Linda F Fried; Joachim H Ix; Jose Luchsinger; Mark J Sarnak; Michael G Shlipak; David S Siscovick; Bryan Kestenbaum Journal: Am J Kidney Dis Date: 2009-09-25 Impact factor: 8.860
Authors: Caroline S Fox; Martin G Larson; Eric P Leip; Bruce Culleton; Peter W F Wilson; Daniel Levy Journal: JAMA Date: 2004-02-18 Impact factor: 56.272
Authors: Heather M Johnson; Lisa Sullivan-Vedder; KyungMann Kim; Patrick E McBride; Maureen A Smith; Jamie N LaMantia; Jennifer T Fink; Megan R Knutson Sinaise; Laura M Zeller; Diane R Lauver Journal: Contemp Clin Trials Date: 2019-01-21 Impact factor: 2.226
Authors: Vanessa Grubbs; Eric Vittinghoff; James D Beck; Abhijit V Kshirsagar; Wei Wang; Michael E Griswold; Neil R Powe; Adolfo Correa; Bessie Young Journal: J Periodontol Date: 2015-06-25 Impact factor: 6.993
Authors: Vanessa Grubbs; Eric Vittinghoff; George Taylor; Donna Kritz-Silverstein; Neil Powe; Kirsten Bibbins-Domingo; Areef Ishani; Steven R Cummings Journal: Nephrol Dial Transplant Date: 2015-08-27 Impact factor: 5.992
Authors: Bessie A Young; Ronit Katz; L Ebony Boulware; Bryan Kestenbaum; Ian H de Boer; Wei Wang; Tibor Fülöp; Nisha Bansal; Cassianne Robinson-Cohen; Michael Griswold; Neil R Powe; Jonathan Himmelfarb; Adolfo Correa Journal: Am J Kidney Dis Date: 2016-04-09 Impact factor: 8.860
Authors: Robert E Olivo; Clemontina A Davenport; Clarissa J Diamantidis; Nrupen A Bhavsar; Crystal C Tyson; Rasheeda Hall; Aurelian Bidulescu; Bessie Young; Stanford E Mwasongwe; Jane Pendergast; L Ebony Boulware; Julia J Scialla Journal: Nephrol Dial Transplant Date: 2018-06-01 Impact factor: 5.992
Authors: Maria Azrad; Cindy K Blair; Cheryl L Rock; Rebecca L Sedjo; Kathleen Y Wolin; Wendy Demark-Wahnefried Journal: Breast Cancer Res Treat Date: 2019-05-09 Impact factor: 4.872