Body Mass Index and Early Kidney Function Decline in Young Adults: A Longitudinal Analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) Study

作者：Grubbs Vanessa^*; Lin Feng; Vittinghoff Eric; Shlipak Michael G; Peralta Carmen A; Bansal Nisha; Jacobs David R; Siscovick David S; Lewis Cora E; Bibbins Domingo Kirsten

来源：American Journal of Kidney Diseases, 2014, 63(4): 590-597.

DOI：10.1053/j.ajkd.2013.10.055

• Kidney function decline
• obesity
• risk factor

Background: Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline.
Study Design: Longitudinal cohort.
Setting & Participants: 2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFR(cys)). > 90 mL/min/1.73 m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
Predictor: BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and 40.0 kg/m(2).
Outcomes: Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFR(cys) < 60 mL/min/1.73 m(2) over 10 years of follow-up.
Measurements: GFR(cys) estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20.
Results: At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114 mL/min/1.73 m(2), and 24.5% had BMI 30.0 kg/m(2). After age 30 years, average eGFR(cys) was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and $ 40.0 kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFR(cys) < 60 mL/min/1.73 m(2). In unadjusted analysis, higher BMI category was associated with incident eGFR(cys) < 60 mL/min/1.73 m (2) (for 25.0-29.9, 30.0-39.9, and 40.0 kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant.
Limitations: Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level.
Conclusions: Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.

• 出版日期2014-4