Joint associations of obesity and estimated GFR with clinical outcomes: a population-based cohort study.

BMC Nephrol 2019 Jun 6;20(1):204. Epub 2019 Jun 6.

Department of Medicine, University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.

Background: Despite the interrelationships between obesity, eGFR and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes.

Methods: We examined the joint associations between obesity, eGFR and albuminuria on four clinical outcomes (death, end-stage renal disease [ESRD], myocardial infarction [MI], and placement in a long-term care facility) using a population-based cohort with procedures from Alberta. Obesity was defined by body mass index ≥35 kg/m as defined by a fee modifier applied to an eligible procedure.

Results: We studied 1,293,362 participants, of whom 171,650 (13.3%) had documented obesity (BMI ≥ 35 kg/m based on claims data) and 1,121,712 (86.7%) did not. The association between eGFR and death was J-shaped for participants with and without documented obesity. After full adjustment, obesity tended to be associated with slightly lower odds of mortality (OR range 0.71-1.02; p for interaction between obesity and eGFR 0.008). For participants with and without obesity, the adjusted odds of ESRD were lowest for participants with eGFR > 90 mL/min*1.73m and increased with lower eGFR, with no evidence of an interaction with obesity (p = 0.37). Although albuminuria and obesity were both associated with higher odds of ESRD, the excess risk associated with obesity was substantially attenuated at higher levels of albuminuria (p for interaction 0.0006). The excess risk of MI associated with obesity was observed at eGFR > 60 mL/min*1.73m but not at lower eGFR (p for interaction < 0.0001). Participants with obesity had a higher adjusted likelihood of placement in long-term care than those without, and the likelihood of such placement was higher at lower eGFR for those with and without obesity (p for interaction = 0.57).

Conclusions: We found significant interactions between obesity and eGFR and/or albuminuria on the likelihood of adverse outcomes including death and ESRD. Since obesity is common, risk prediction tools for people with CKD might be improved by adding information on BMI or other proxies for body size in addition to eGFR and albuminuria.

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Article in Lancet.
M Ng et al.
Lancet. 2014
Article in N Engl J Med
A Afshin et al.
N Engl J Med 2017
Article in Can J Kidney Health Dis
CP Kovesdy et al.
Can J Kidney Health Dis 2017
Article in Jama.
BR Hemmelgarn et al.
Jama. 2010
Article in Am J Kidney Dis
EF Elsayed et al.
Am J Kidney Dis 2008
Article in Am J Kidney Dis
SJ Pinto-Sietsma et al.
Am J Kidney Dis 2003
Article in Ann Intern Med
CY Hsu et al.
Ann Intern Med 2006
Article in Arch Intern Med
A Vivante et al.
Arch Intern Med 2012
Article in Lancet.
A Romero-Corral et al.
Lancet. 2006
Article in Am Heart J
A Oreopoulos et al.
Am Heart J 2008
Article in PLoS One
L Oesch et al.
PLoS One 2017

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