Adiposity and risk of decline in glomerular filtration rate

Meta-analysis of individual participant data in a global consortium

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, Enei Ri, Katsuyuki Miura, Sankar D. Navaneethan, Paul J. Roderick, Jose M. Valdivielso, Frank L.J. Visseren, Luxia Zhang & 6 others Ron T. Gansevoort, Stein I. Hallan, Andrew S. Levey, Kunihiro Matsushita, Varda Shalev, Mark Woodward

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numberk5301
JournalBMJ (Online)
Volume364
DOIs
Publication statusPublished - 01-01-2019

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Adiposity
Glomerular Filtration Rate
Meta-Analysis
Body Mass Index
Waist Circumference
Chronic Renal Insufficiency
Population
Renal Replacement Therapy
Mortality
Chronic Kidney Failure
Comorbidity
Smoking
Outcome Assessment (Health Care)
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chang, A. R., Grams, M. E., Ballew, S. H., Bilo, H., Correa, A., Evans, M., ... Woodward, M. (2019). Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium. BMJ (Online), 364, [k5301]. https://doi.org/10.1136/bmj.k5301
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. ; Ri, Enei ; 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 ; Woodward, Mark. / Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium. In: BMJ (Online). 2019 ; Vol. 364.
@article{93d2700656804a87b7cb23bc3a5e4689,
title = "Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium",
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.",
author = "Chang, {Alex R.} and Grams, {Morgan E.} and Ballew, {Shoshana H.} and Henk Bilo and Adolfo Correa and Marie Evans and Gutierrez, {Orlando M.} and Farhad Hosseinpanah and Kunitoshi Iseki and Timothy Kenealy and Barbara Klein and Florian Kronenberg and Lee, {Brian J.} and Enei Ri and Katsuyuki Miura and Navaneethan, {Sankar D.} and Roderick, {Paul J.} and Valdivielso, {Jose M.} and Visseren, {Frank L.J.} and Luxia Zhang and Gansevoort, {Ron T.} and Hallan, {Stein I.} and Levey, {Andrew S.} and Kunihiro Matsushita and Varda Shalev and Mark Woodward",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/bmj.k5301",
language = "English",
volume = "364",
journal = "British Medical Journal",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

Chang, AR, Grams, ME, Ballew, SH, Bilo, H, Correa, A, Evans, M, Gutierrez, OM, Hosseinpanah, F, Iseki, K, Kenealy, T, Klein, B, Kronenberg, F, Lee, BJ, Ri, E, Miura, K, Navaneethan, SD, Roderick, PJ, Valdivielso, JM, Visseren, FLJ, Zhang, L, Gansevoort, RT, Hallan, SI, Levey, AS, Matsushita, K, Shalev, V & Woodward, M 2019, 'Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium', BMJ (Online), vol. 364, k5301. https://doi.org/10.1136/bmj.k5301

Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium. / 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.; Ri, Enei; 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; Woodward, Mark.

In: BMJ (Online), Vol. 364, k5301, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adiposity and risk of decline in glomerular filtration rate

T2 - Meta-analysis of individual participant data in a global consortium

AU - Chang, Alex R.

AU - Grams, Morgan E.

AU - Ballew, Shoshana H.

AU - Bilo, Henk

AU - Correa, Adolfo

AU - Evans, Marie

AU - Gutierrez, Orlando M.

AU - Hosseinpanah, Farhad

AU - Iseki, Kunitoshi

AU - Kenealy, Timothy

AU - Klein, Barbara

AU - Kronenberg, Florian

AU - Lee, Brian J.

AU - Ri, Enei

AU - Miura, Katsuyuki

AU - Navaneethan, Sankar D.

AU - Roderick, Paul J.

AU - Valdivielso, Jose M.

AU - Visseren, Frank L.J.

AU - Zhang, Luxia

AU - Gansevoort, Ron T.

AU - Hallan, Stein I.

AU - Levey, Andrew S.

AU - Matsushita, Kunihiro

AU - Shalev, Varda

AU - Woodward, Mark

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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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