Paras P Shah1, Tammy M Brady2, Kevin E C Meyers3,4, Michelle M O'Shaughnessy5, Keisha L Gibson6, Tarak Srivastava7, Jarcy Zee8, Daniel Cattran9, Katherine R Tuttle10, Crystal Gadegbeku11, Dorey Glenn6, Vimal Derebail6, Abigail Smith8, Chia-Shi Wang12, Brenda W Gillespie13, Markus Bitzer14, Christine B Sethna15,16. 1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA. 2. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 3. The Children Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Department of Nephrology, University College Cork, Cork, Ireland. 6. UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 7. Children's Mercy Hospital, Kansas City, Missouri, USA. 8. Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA. 9. Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. 10. Providence Health Care, University of Washington, Spokane, Washington, USA. 11. Temple University School of Medicine, Philadelphia, Pennsylvania, USA. 12. Emory University School of Medicine, Atlanta, Georgia, USA. 13. Consulting for Statistics, Computing and Analytics Research and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. 14. Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA. 15. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA, csethna@northwell.edu. 16. Cohen Children's Medical Center of NY, New Hyde Park, New York, USA, csethna@northwell.edu.
Abstract
BACKGROUND/AIMS: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. METHODS: In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots. RESULTS: The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001). CONCLUSION: Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.
BACKGROUND/AIMS: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. METHODS: In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots. RESULTS: The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001). CONCLUSION: Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.
Authors: Christine B Sethna; Derek K Ng; Shuai Jiang; Jeff Saland; Bradley A Warady; Susan Furth; Kevin E Meyers Journal: Pediatr Nephrol Date: 2019-03-22 Impact factor: 3.714
Authors: Ana Tobar; Yaacov Ori; Sydney Benchetrit; Gai Milo; Michal Herman-Edelstein; Boris Zingerman; Netta Lev; Uzi Gafter; Avry Chagnac Journal: PLoS One Date: 2013-09-25 Impact factor: 3.240
Authors: Amy J Kogon; Jennifer Roem; Michael F Schneider; Mark M Mitsnefes; Babette S Zemel; Bradley A Warady; Susan L Furth; Nancy M Rodig Journal: Pediatr Nephrol Date: 2022-08-26 Impact factor: 3.651