Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium.
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Version: Final published version
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Secondary document(s)
Download: Chang Adiposity GFR decline risk CKD-PC suppl BMJ 2019.pdf (1484.35 [Ko])
State: Public
Version: Supplementary document
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State: Public
Version: Supplementary document
License: Not specified
Serval ID
serval:BIB_736EC718CEAF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium.
Journal
BMJ
Working group(s)
CKD Prognosis Consortium (CKD-PC)
Contributor(s)
Astor B., Appel L., Greene T., Chen T., Chalmers J., Arima H., Perkovic V., Yatsuya H., Tamakoshi K., Hirakawa Y., Coresh J., Sang Y., Polkinghorne K., Chadban S., Atkins R., Levin A., Djurdjev O., Klein R., Lee K., Liu L., Zhao M., Wang F., Wang J., Tang M., Heine G., Emrich I., Zawada A., Bauer L., Nally J., Schold J., Shlipak M., Sarnak M., Katz R., Hiramoto J., Iso H., Yamagishi K., Umesawa M., Muraki I., Fukagawa M., Maruyama S., Hamano T., Hasegawa T., Fujii N., Jafar T., Hatcher J., Poulter N., Chaturvedi N., Wheeler D., Emberson J., Townend J., Landray M., Brenner H., Schöttker B., Saum K.U., Rothenbacher D., Fox C., Hwang S.J., Köttgen A., Schneider M.P., Eckardt K.U., Green J., Kirchner H.L., Ito S., Miyazaki M., Nakayama M., Yamada G., Cirillo M., Romundstad S., Øvrehus M., Langlo K.A., Irie F., Sairenchi T., Rebholz C.M., Young B., Boulware L.E., Ishikawa S., Yano Y., Kotani K., Nakamura T., Jee S.H., Kimm H., Mok Y., Chodick G., Wetzels JFM, Blankestijn P.J., van Zuilen A.D., Bots M., Sarnak M., Inker L., Peralta C., Kollerits B., Ritz E., Nitsch D., Fletcher A., Bottinger E., Nadkarni G.N., Ellis S.B., Nadukuru R., Fernandez E., Betriu A., Bermudez-Lopez M., Stengel B., Metzger M., Flamant M., Houillier P., Haymann J.P., Froissart M., Ueshima H., Okayama A., Tanaka S., Okamura T., Elley C.R., Collins J.F., Drury P.L., Ohkubo T., Asayama K., Metoki H., Kikuya M., Nakayama M., Iseki C., Nelson R.G., Knowler W.C., Bakker SJL, Heerspink HJL, Brunskill N., Major R., Shepherd D., Medcalf J., Jassal S.K., Bergstrom J., Ix J.H., Barrett-Connor E., Kovesdy C., Kalantar-Zadeh K., Sumida K., Muntner P., Warnock D., Judd S., Panwar B., de Zeeuw D., Brenner B., Sedaghat S., Ikram M.A., Hoorn E.J., Dehghan A., Wong T.Y., Sabanayagam C., Cheng C.Y., Banu R., Segelmark M., Stendahl M., Schön S., Tangri N., Sud M., Naimark D., Wen C.P., Tsao C.K., Tsai M.K., Chen C.H., Konta T., Hirayama A., Ichikawa K., Hadaegh F., Mirbolouk M., Azizi F., Solbu M.D., Jenssen T.G., Eriksen B.O., Eggen A.E., Lannfelt L., Larsson A., Ärnlöv J., Landman GWD, van Hateren KJJ, Kleefstra N., Chen J., Kwak L., Surapaneni A.
ISSN
1756-1833 (Electronic)
ISSN-L
0959-8138
Publication state
Published
Issued date
10/01/2019
Peer-reviewed
Oui
Volume
364
Pages
k5301
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
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.
Individual participant data meta-analysis.
Cohorts from 40 countries with data collected between 1970 and 2017.
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).
GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m <sup>2</sup> ) and all cause mortality.
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.
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.
Individual participant data meta-analysis.
Cohorts from 40 countries with data collected between 1970 and 2017.
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).
GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m <sup>2</sup> ) and all cause mortality.
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.
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.
Pubmed
Open Access
Yes
Create date
18/01/2019 11:48
Last modification date
20/08/2019 15:31
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