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

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

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.

0959-8146
Chang, Alex R.
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Grams, Morgan E.
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Ballew, Shoshana H.
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Bilo, Henk
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Correa, Adolfo
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Evans, Marie
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Roderick, Paul J.
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Valdivielso, Jose M.
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Visseren, Frank L.J.
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Matsushita, Kunihiro
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Shalev, Varda
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Woodward, Mark
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Li, Yuanying
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Woodward, Mark
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Chang, Alex R., Grams, Morgan E., Ballew, Shoshana H., Bilo, Henk, Correa, Adolfo, Evans, Marie, Gutierrez, Orlando M., Hosseinpanah, Farhad, Iseki, Kunitoshi, Kenealy, Timothy, Klein, Barbara, Kronenberg, Florian, Lee, Brian J., Li, Yuanying, Miura, Katsuyuki, Navaneethan, Sankar D., Roderick, Paul J., Valdivielso, Jose M., Visseren, Frank L.J., Zhang, Luxia, Gansevoort, Ron T., Hallan, Stein I., Levey, Andrew S., Matsushita, Kunihiro, Shalev, Varda and Woodward, Mark (2019) Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium. British Medical Journal, 364 (8182). (doi:10.1136/bmj.k5301).

Record type: Article

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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Accepted/In Press date: 7 November 2018
e-pub ahead of print date: 10 January 2019
Published date: 2019

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Local EPrints ID: 427552
URI: https://eprints.soton.ac.uk/id/eprint/427552
ISSN: 0959-8146
PURE UUID: d9961ded-3096-4c56-8cd7-4f3755b7a90d
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 23 Jan 2019 17:30
Last modified: 14 Mar 2019 01:52

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Contributors

Author: Alex R. Chang
Author: Morgan E. Grams
Author: Shoshana H. Ballew
Author: Henk Bilo
Author: Adolfo Correa
Author: Marie Evans
Author: Orlando M. Gutierrez
Author: Farhad Hosseinpanah
Author: Kunitoshi Iseki
Author: Timothy Kenealy
Author: Barbara Klein
Author: Florian Kronenberg
Author: Brian J. Lee
Author: Yuanying Li
Author: Katsuyuki Miura
Author: Sankar D. Navaneethan
Author: Jose M. Valdivielso
Author: Frank L.J. Visseren
Author: Luxia Zhang
Author: Ron T. Gansevoort
Author: Stein I. Hallan
Author: Andrew S. Levey
Author: Kunihiro Matsushita
Author: Varda Shalev
Author: Mark Woodward

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