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

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posted on 30.04.2020, 15:25 by Alex R Chang, Morgan E Grams, Shoshana H Ballew, Henk Bilo, Adolfo Correa, Marie Evans, Orlando M Gutierrez, Farhad Hosseinpanah, Kunitoshi Iseki, Timothy Kenealy, Barbara Klein, Florian Kronenberg, Brian J Lee, Yuanying Li, Katsuyuki Miura, Sankar D Navaneethan, Paul J Roderick, Jose M Valdivielso, Frank LJ Visseren, Luxia Zhang, Ron T Gansevoort, Stein I Hallan, Andrew S Levey, Kunihiro Matsushita, Varda Shalev, Mark Woodward, Brad Astor, Larry Appel, Greene, Teresa Chen, John Chalmers, Hisatomi Arima, Vlado Perkovic, Hiroshi Yatsuya, Koji Tamakoshi, Yoshihisa Hirakawa, Josef Coresh, Morgan Grams, Yingying Sang, Kevan Polkinghorne, Steven Chadban, Robert Atkins, Adeera Levin, Ognjenka Djurdjev, Beaver Dam, Ron Klein, Kristine Lee, Lisheng Liu, Minghui Zhao, Fang Wang, Jinwei Wang, Mila Tang, Gunnar Heine, Insa Emrich, Adam Zawada, Lucie Bauer, Joseph Nally, Sankar Navaneethan, Jesse Schold, Michael Shlipak, Mark Sarnak, Ronit Katz, Jade Hiramoto, Hiroyasu Iso, Kazumasa Yamagishi, Mitsumasa Umesawa, Isao Muraki, Masafumi Fukagawa, Shoichi Maruyama, Takayuki Hamano, Takeshi Hasegawa, Naohiko Fujii, Tazeen Jafar, Juanita Hatcher, Neil Poulter, Nish Chaturvedi, David Wheeler, John Emberson, John Townend, Martin Landray, Hermann, Brenner, Ben Schottker, Kai-Uwe Saum, Dietrich Rothenbacher, Caroline Fox, Shih-Jen Hwang, Anna Kottgen, Markus P Schneider, Kai-Uwe Eckardt, Jamie Green, H Lester Kirchner, Sadayoshi Ito, Mariko Miyazaki, Masaaki Nakayama, Gen Yamada, Massimo Cirillo, Stein Hallan, Solfrid Romundstad, Marius Ovrehus, Knut Asbjorn Langlo, Fujiko Irie, Toshimi Sairenchi, Casey M Rebholz, Bessie Young, L Ebony Boulware, Shizukiyo Ishikawa, Yuichiro Yano, Kazuhiko Kotani, Takeshi Nakamura, Sun Ha Jee, Heejin Kimm, Yejin Mok, Gabriel Chodick, Jack FM Wetzels, Peter J Blankestijn, Arjan D van Zuilen, M Bots, Lesley Inker, Carmen Peralta, Barbara Kollerits, Eberhard Ritz, Dorothea Nitsch, Paul Roderick, Astrid Fletcher, Erwin Bottinger, Girish N Nadkarni, Stephen B Ellis, Rajiv Nadukuru, Elvira Fernandez, Angels Betriu, Marcelino Bermudez-Lopez, Benedicte Stengel, Marie Metzger, Martin Flamant, Pascal Houillier, Jean-Philippe Haymann, Marc Froissart, Hirotsugu Ueshima, Akira Okayama, Sachiko Tanaka, Tomonori Okamura, C Raina Elley, John F Collins, Paul L Drury, Takayoshi Ohkubo, Kei Asayama, Hirohito Metoki, Masahiro Kikuya, Chiho Iseki, Robert G Nelson, William C Knowler, Stephan JL Bakker, Hiddo JL Heerspink, Nigel Brunskill, Rupert Major, David Shepherd, James Medcalf, Rancho Bernardo, Simerjot K Jassal, Jaclyn Bergstrom, H Joachim, Elizabeth Barrett-Connor, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Keiichi Sumida, Paul Muntner, David Warnock, Suzanne Judd, Bhupesh Panwar, Dick de Zeeuw, Barry Brenner, Sanaz Sedaghat, M Arfan Ikram, Ewout J Hoorn, Abbas Dehghan, Tien Yin Wong, Charumathi Sabanayagam, Ching-Yu Cheng, Riswana Banu Binte, Mohamed Abdul Sokor, Marten Segelmark, Maria Stendahl, Staffan Schon, Navdeep Tangri, Maneesh Sud, David Naimark, Chi-Pang Wen, Keng Tsao, Min-Kugng Tsai, Chien-Hua Chen, Tsuneo Konta, Atsushi Hirayama, Kazunobu Ichikawa, Farzad Hadaegh, Mohammadhassan Mirbolouk, Fereidoun Azizi, Marit Dahl Solbu, Trond Geir Jenssen, Bjorn Odvar Eriksen, Anne Elise Eggen, Lars Lannfelt, Anders Larsson, Johan Arnlov, Henk JG Bilo, Gijs WD Landman, Kornelis JJ Van Hateren, Nanne Kleefstra, Csaba P Kovesdy, Mark Woodward., Jingsha Chen, Lucia Kwak, Aditya Surapaneni
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 m2) 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.

Funding

The CKD-PC data coordinating centre is funded partly by a programme grant from the US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; R01DK100446-01). Various sources have supported enrolment and data collection including laboratory measurements, and follow-up in the collaborating cohorts of the CKD-PC; these funding sources include government agencies such as national institutes of health and medical research councils as well as foundations and industry sponsors listed in eAppendix 3. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. ARC was supported by NIDDK (1K23DK106515-01).

History

Citation

BMJ 2019;364:k5301

Author affiliation

College of Life Sciences

Version

VoR (Version of Record)

Published in

BMJ

Volume

364

Publisher

BMJ Publishing Group

issn

1759-2151

eissn

1756-1833

Acceptance date

07/11/2018

Copyright date

2019

Publisher version

https://www.bmj.com/content/364/bmj.k5301

Language

English