Prevention of Renal and Vascular End- Stage Disease (PREVEND) Study 88 Pinto-Sietsma SJ, Navis G, Janssen WM, de Zeeuw D, Gans RO, de Jong PE; PREVEND Study Group. A central body fat distribution is related to renal function impairment, even in lean subjects. Am J Kidney Dis 2003;41:733-41. DOI: http://dx.doi.org/10.1016/S0272-6386(03)00020-9
http://dx.doi.org/10.1016/S0272-6386(03)...
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7,676 Dutch individuals without diabetes |
Elevated BMI (overweight and obese ), and central fat distribution (waist-hip ratio) |
-Presence of urine albumin 30-300 mg/24h -Elevated and diminished GFR |
-Obese + central fat: higher risk of albuminuria -Obese +/- central fat: higher risk of elevated GFR -Central fat +/- obesity associated with diminished filtration |
Cross sectional analysis |
Multinational study of hypertensive outpatients 2020 Thoenes M, Reil JC, Khan BV, Bramlage P, Volpe M, Kirch W, et al. Abdominal obesity is associated with microalbuminuria and an elevated cardiovascular risk profile in patients with hypertension. Vasc Health Risk Manag 2009;5:577-85.
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20,828 patients from 26 countries |
BMI and waist circumference |
Prevalence of albuminuria by dip stick |
Higher waist circumference associated with albuminuria independent of BMI |
Cross sectional analysis |
Framingham Multi-Detector Computed Tomography (MDCT) cohort 2222 Foster MC, Hwang SJ, Massaro JM, Hoffmann U, DeBoer IH, Robins SJ, et al. Association of subcutaneous and visceral adiposity with albuminuria: the Framingham Heart Study. Obesity (Silver Spring) 2011;19:1284-9. DOI: http://dx.doi.org/10.1038/oby.2010.308
http://dx.doi.org/10.1038/oby.2010.308...
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3,099 individuals |
Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) |
Prevalence of UACR > 25 mg/g in women and > 17 mg/g in men |
VAT associated with albuminuria in men, but not in women |
Cross sectional analysis |
CARDIA (Coronary Artery Risk Development in Young Adults) study 1111 Chang A, Van Horn L, Jacobs DR Jr, Liu K, Muntner P, Newsome B, et al. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Kidney Dis 2013;62:267-75. DOI: http://dx.doi.org/10.1053/j.ajkd.2013.02.363
http://dx.doi.org/10.1053/j.ajkd.2013.02...
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2,354 community-dwelling individuals with normal kidney function aged 28-40 years |
-Obesity (BMI > 30 kg/m2) -Diet and lifestyle-related factors |
Incident microalbuminuria |
Obesity (OR 1.9) and unhealthy diet (OR 2.0) associated with incident albuminuria |
Low number of events |
Hypertension Detection and Follow-Up Program 1010 Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 2005;46:587-94. DOI: http://dx.doi.org/10.1053/j.ajkd.2005.06.007
http://dx.doi.org/10.1053/j.ajkd.2005.06...
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5,897 hypertensive adults |
Overweight and obese BMIvs. normal BMI |
Incident CKD (1+ or greater proteinuria on urinalysis and/or an eGFR < 60 mL/ min/1.73 m2) |
Both overweight (OR 1.21) and obesity (OR 1.40) associated with incident CKD |
Results unchanged after excluding diabetics |
Framingham Offspring Study 99 Foster MC, Hwang SJ, Larson MG, Lichtman JH, Parikh NI, Vasan RS, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis 2008;52:39-48. PMID: 18440684 DOI: http://dx.doi.org/10.1053/j.ajkd.2008.03.003
http://dx.doi.org/10.1053/j.ajkd.2008.03...
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2,676 individuals free of CKD stage 3 |
High vs. normal BMI
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-Incident CKD stage 3 -Incident proteinuria |
-Higher BMI not associated with CKD3 after adjustments -Higher BMI associated with increased odds of incident proteinuria |
Predominantly white, limited geography |
Physicians' Health Study1313 Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871-80. DOI: http://dx.doi.org/10.1053/j.ajkd.2005.08.015
http://dx.doi.org/10.1053/j.ajkd.2005.08...
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11,104 initially healthy men in US |
-BMI quintiles -Increase in BMI over time (vs. stable BMI) |
Incident eGFR < 60 mL/min/1.73 m2
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-Higher baseline BMI and increase in BMI over time both associated with higher risk of incident CKD |
Exclusively men |
Nation-wide US Veterans Administration cohort 1414 Lu JL, Molnar MZ, Naseer A, Mikkelsen MK, Kalantar-Zadeh K, Kovesdy CP. Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol 2015;3:704-14. DOI: http://dx.doi.org/10.1016/S2213-8587(15)00128-X
http://dx.doi.org/10.1016/S2213-8587(15)...
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3,376,187 US veterans with baseline eGFR ≥ 60 mL/min/1.73 m2
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BMI categories from < 20 to > 50 kg/m2
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Rapid decline in kidney function (negative eGFR slope of > 5 mL/ min/1.73 m2) |
BMI > 30 kg/m2 associated with rapid loss of kidney function |
Associations more accentuated in older individuals |
Nation-wide population-based study from Sweden 1212 Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O. Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006;17:1695-702. DOI: http://dx.doi.org/10.1681/ASN.2005060638
http://dx.doi.org/10.1681/ASN.2005060638...
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926 Swedes with moderate/advanced CKD compared to 998 controls |
BMI ≥ 25 vs. < 25 kg/m2
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CKD vs. no CKD |
Higher BMI associated with 3x higher risk of CKD |
-Risk strongest in diabetics, but also significantly higher in non-diabetics -Cross sectional analysis |
Nation-wide population based study in Israel 1717 Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Intern Med 2012;172:1644-50. DOI: http://dx.doi.org/10.1001/2013.jamainternmed.85
http://dx.doi.org/10.1001/2013.jamainter...
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1,194,704 adolescent males and females examined for military service |
Elevated BMI (overweight and obesity) vs. normal BMI
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Incident ESRD |
Overweight (HR 3.0) and obesity (HR 6.89) associated with higher risk of ESRD |
Associations strongest for diabetic ESRD, but also significantly higher for non-diabetic ESRD |
The Nord- Trøndelag Health Study (HUNT-1) 1515 Munkhaugen J, Lydersen S, Widerøe TE, Hallan S. Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. Am J Kidney Dis 2009;54:638-46. DOI: http://dx.doi.org/10.1053/j.ajkd.2009.03.023
http://dx.doi.org/10.1053/j.ajkd.2009.03...
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74,986 Norwegian adults |
BMI categories
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Incidence of ESRD or renal death |
BMI > 30 kg/m2 associated with worse outcomes |
Associations not present in individuals with BL < 120/80 mmHg |
Community-based screening in Okinawa, Japan 1616 Iseki K, Ikemiya Y, Kinjo K, Inoue T, Iseki C, Takishita S. Body mass index and the risk of development of end-stage renal disease in a screened cohort. Kidney Int 2004;65:1870-6. DOI: http://dx.doi.org/10.1111/j.1523-1755.2004.00582.x
http://dx.doi.org/10.1111/j.1523-1755.20...
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100,753 individuals > 20 years old |
BMI quartiles |
Incidence of ESRD |
Higher BMI associated with increased risk of ESRD in men, but not in women |
Average BMI lower in Japan compared to Western countries |
Nation-wide US Veterans Administration cohort 1919 Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol 2014;25:2088-96. DOI: http://dx.doi.org/10.1681/ASN.2013070754
http://dx.doi.org/10.1681/ASN.2013070754...
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453,946 US veterans with baseline eGFR < 60 ml/min per 1.73 m2
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BMI categories from < 20 to > 50 kg/m2
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-Incidence of ESRD -Doubling of serum creatinine -Slopes of eGFR |
Moderate and severe obesity associated with worse renal outcomes |
Associations present but weaker in patients with more advanced CKD |
Kaiser Permanente Northern California 1818 Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21-8. PMID: 16389251 DOI: http://dx.doi.org/10.7326/0003-4819-144-1-200601030-00006
http://dx.doi.org/10.7326/0003-4819-144-...
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320,252 adults with and without baseline CKD |
Overweight, class I, II and extreme obesity; vs. normal BMI
|
Incidence of ESRD |
Linearly higher risk of ESRD with higher BMI categories |
Associations remained present after adjustment for DM, hypertension and baseline CKD |
REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study 2121 Kramer H, Gutiérrez OM, Judd SE, Muntner P, Warnock DG, Tanner RM, et al. Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis 2016;67:62-9. DOI: http://dx.doi.org/10.1053/j.ajkd.2015.05.023
http://dx.doi.org/10.1053/j.ajkd.2015.05...
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30,239 individuals |
Elevated waist circumference or BMI |
Incidence of ESRD |
BMI above normal not associated with ESRD after adjustment for waist circumference -Higher waist circumference associated with ESRD |
Association of waist circumference with ESRD became on-significant after adjustment for comorbidities and baseline eGFR and proteinuria |