Alex Chang1, Tom H Greene2, Xuelei Wang3, Cynthia Kendrick4, Holly Kramer5, Jackson Wright6, Brad Astor7, Tariq Shafi8, Robert Toto9, Julia Lewis10, Lawrence J Appel11, Morgan Grams12. 1. Division of Nephrology, Geisinger Health System, Danville, PA, USA. 2. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA. 3. Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, USA. 4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. 5. Division of Nephrology, Loyola University Medical Center, Maywood, NJ, USA. 6. Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA. 7. Division of Nephrology, University of Wisconsin, Madison, WI, USA. 8. School of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA. 9. Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 10. Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA. 11. Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. 12. School of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Abstract
BACKGROUND: Little is known about the effect of weight loss/gain on kidney function. Analyses are complicated by uncertainty about optimal body surface indexing strategies for measured glomerular filtration rate (mGFR). METHODS: Using data from the African-American Study of Kidney Disease and Hypertension (AASK), we determined the association of change in weight with three different estimates of change in kidney function: (i) unindexed mGFR estimated by renal clearance of iodine-125-iothalamate, (ii) mGFR indexed to concurrently measured BSA and (iii) GFR estimated from serum creatinine (eGFR). All models were adjusted for baseline weight, time, randomization group and time-varying diuretic use. We also examined whether these relationships were consistent across a number of subgroups, including tertiles of baseline 24-h urine sodium excretion. RESULTS: In 1094 participants followed over an average of 3.6 years, a 5-kg weight gain was associated with a 1.10 mL/min/1.73 m(2) (95% CI: 0.87 to 1.33; P < 0.001) increase in unindexed mGFR. There was no association between weight change and mGFR indexed for concurrent BSA (per 5 kg weight gain, 0.21; 95% CI: -0.02 to 0.44; P = 0.1) or between weight change and eGFR (-0.09; 95% CI: -0.32 to 0.14; P = 0.4). The effect of weight change on unindexed mGFR was less pronounced in individuals with higher baseline sodium excretion (P = 0.08 for interaction). CONCLUSION: The association between weight change and kidney function varies depending on the method of assessment. Future clinical trials should examine the effect of intentional weight change on measured GFR or filtration markers robust to changes in muscle mass.
BACKGROUND: Little is known about the effect of weight loss/gain on kidney function. Analyses are complicated by uncertainty about optimal body surface indexing strategies for measured glomerular filtration rate (mGFR). METHODS: Using data from the African-American Study of Kidney Disease and Hypertension (AASK), we determined the association of change in weight with three different estimates of change in kidney function: (i) unindexed mGFR estimated by renal clearance of iodine-125-iothalamate, (ii) mGFR indexed to concurrently measured BSA and (iii) GFR estimated from serum creatinine (eGFR). All models were adjusted for baseline weight, time, randomization group and time-varying diuretic use. We also examined whether these relationships were consistent across a number of subgroups, including tertiles of baseline 24-h urine sodium excretion. RESULTS: In 1094 participants followed over an average of 3.6 years, a 5-kg weight gain was associated with a 1.10 mL/min/1.73 m(2) (95% CI: 0.87 to 1.33; P < 0.001) increase in unindexed mGFR. There was no association between weight change and mGFR indexed for concurrent BSA (per 5 kg weight gain, 0.21; 95% CI: -0.02 to 0.44; P = 0.1) or between weight change and eGFR (-0.09; 95% CI: -0.32 to 0.14; P = 0.4). The effect of weight change on unindexed mGFR was less pronounced in individuals with higher baseline sodium excretion (P = 0.08 for interaction). CONCLUSION: The association between weight change and kidney function varies depending on the method of assessment. Future clinical trials should examine the effect of intentional weight change on measured GFR or filtration markers robust to changes in muscle mass.
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